Provider Demographics
NPI:1700800877
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:VANDERBILT CHILDRENS HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-4559
Mailing Address - Street 1:2200 CHILDRENS WAY
Mailing Address - Street 2:ROOM 2106A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-9650
Mailing Address - Country:US
Mailing Address - Phone:615-936-6337
Mailing Address - Fax:615-936-4531
Practice Address - Street 1:2200 CHILDRENS WAY
Practice Address - Street 2:ROOM 2106A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-9650
Practice Address - Country:US
Practice Address - Phone:615-936-6337
Practice Address - Fax:615-936-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336S0011X
TN58043336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093997OtherPK
TNBV8530164OtherDEA
4436956OtherNCPDP