Provider Demographics
NPI:1982779286
Name:DUKE UNIVERSITY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:DUKE UNIVERSITY HEALTH SYSTEM, INC.
Other - Org Name:DUHS CHILDREN'S OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-613-8995
Mailing Address - Street 1:PO BOX 110566
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-5566
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:ERWIN RD
Practice Address - Street 2:CHILDRENS HEALTH CENTER ROOM 1937
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-668-4111
Practice Address - Fax:919-668-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC075453336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1291544Medicaid
KY5400990700Medicaid
WV0174057001Medicaid
IN200345850AMedicaid
MI3438050Medicaid
NM65123816Medicaid
VA009992227Medicaid
OH9111115Medicaid
GA734920035AMedicaid
ID80686120Medicaid
MS05575002Medicaid
VT1009885Medicaid
SC7N7545Medicaid
NC0326503Medicaid