Provider Demographics
NPI:1891838520
Name:GOOD SAMARITAN HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-885-3864
Mailing Address - Street 1:520 S 7TH ST
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-885-3348
Mailing Address - Fax:812-885-3087
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3348
Practice Address - Fax:812-885-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60001786A3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1517157OtherNCPDP