Provider Demographics
NPI:1932352283
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:VANDERBILT HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:615-322-1909
Mailing Address - Street 1:719 THOMPSON LN
Mailing Address - Street 2:SUITE 24130
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3609
Mailing Address - Country:US
Mailing Address - Phone:615-322-2688
Mailing Address - Fax:615-322-0808
Practice Address - Street 1:719 THOMPSON LN
Practice Address - Street 2:SUITE 24130
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3609
Practice Address - Country:US
Practice Address - Phone:615-322-2688
Practice Address - Fax:615-322-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4593333600000X
3336C0002X, 3336I0012X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118325OtherPK