Provider Demographics
NPI:1508489303
Name:ADVENTIST HEALTH OUTPATIENT PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH OUTPATIENT PHARMACY SERVICES, LLC
Other - Org Name:FORTIFY MARKET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-406-1570
Mailing Address - Street 1:1 ADVENTIST HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3266
Mailing Address - Country:US
Mailing Address - Phone:916-406-0188
Mailing Address - Fax:
Practice Address - Street 1:1 ADVENTIST HEALTH WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3266
Practice Address - Country:US
Practice Address - Phone:916-406-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy