# STATE OF INDIANA AUDITOR OF STATE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MADISON ST HOSPITAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477596757
- **Authorized official:** TIMOTHY PALMER (DIR OF PHCY)
- **Authorized official phone:** (812) 265-7461

## Contact information

- **Practice address:** 711 GREEN RD, MADISON, IN 47250-2143
- **Practice address phone:** (812) 265-7460
- **Practice address fax:** (812) 265-7463
- **Mailing address:** 711 GREEN RD, MADISON, IN 47250-2143
- **Mailing address phone:** (812) 265-7460
- **Mailing address fax:** (812) 265-7463

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | 60000778A | IN | Yes |

## Other

- **Enumeration date:** 06/14/2006
- **Last updated:** 12/03/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100272180A | — | IN |
| 05 | — | 100273320A | — | IN |
| 05 | — | 200829500A | — | IN |
| 01 | — | 2024923 | PK | — |