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
—
—
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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