Provider Demographics
NPI:1972082022
Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.
Other - Org Name:HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC. #136
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-778-7651
Mailing Address - Street 1:29 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1401
Mailing Address - Country:US
Mailing Address - Phone:315-287-3600
Mailing Address - Fax:315-287-4291
Practice Address - Street 1:360 E WYOMISSING AVE STE H
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-1523
Practice Address - Country:US
Practice Address - Phone:610-743-3132
Practice Address - Fax:610-741-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy