Organization
DEACONESS HOSPITAL INC
Active
Other names
Deaconess Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS FITE R.PH. (PHARMACY MANAGER)
(812) 450-3780
Entity
Organization
Contact information
Practice address
600 MARY ST, EVANSVILLE, IN 47710-1658
(812) 450-3784
(812) 450-3781
Mailing address
600 MARY ST, EVANSVILLE, IN 47710-1658
(812) 450-3784
(812) 450-3781
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336I0012X
Institutional Pharmacy
60001691A
IN
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201054000A
—
IN
01
—
2133261
PK
—
Enumeration date
01/12/2012
Last updated
12/14/2016
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