Provider Demographics
NPI:1245059161
Name:ASCENSION PHARMACY SERVICES, LLC.
Entity type:Organization
Organization Name:ASCENSION PHARMACY SERVICES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-592-9705
Mailing Address - Street 1:1363 W CAP CIR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5113
Mailing Address - Country:US
Mailing Address - Phone:815-592-9705
Mailing Address - Fax:
Practice Address - Street 1:775 N EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4937
Practice Address - Country:US
Practice Address - Phone:316-858-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-08
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy