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Organization
STATE OF INDIANA AUDITOR OF STATE
Active
Organization
STATE OF INDIANA AUDITOR OF STATE
Active
Other names
MADISON ST HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY PALMER (DIR OF PHCY)
(812) 265-7461
Entity
Organization
Contact information
Practice address
711 GREEN RD, MADISON, IN 47250-2143
(812) 265-7460
(812) 265-7463
Mailing address
711 GREEN RD, MADISON, IN 47250-2143
(812) 265-7460
(812) 265-7463
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336I0012X
Institutional Pharmacy
Primary
60000778A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100272180A
—
IN
05
—
100273320A
—
IN
05
—
200829500A
—
IN
01
—
2024923
PK
—
Enumeration date
06/14/2006
Last updated
12/03/2015
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