Provider Demographics
NPI:1013051945
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ST. MARY'S MEDICAL CENTER CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-750-5726
Mailing Address - Street 1:450 STANYAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1079
Mailing Address - Country:US
Mailing Address - Phone:415-668-1000
Mailing Address - Fax:415-750-5899
Practice Address - Street 1:2235 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1012
Practice Address - Country:US
Practice Address - Phone:415-750-4878
Practice Address - Fax:415-750-8189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY457913336C0003X
CAHSP457903336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA457910Medicaid
CAPHB457900Medicaid
0545369OtherNCPDP - IP PHARMACY
0545357OtherNCPCP - RETAIL PHARMACY
721561126OtherIRS - SP TAX ID