Organization
DEACONESS HOSPITAL, INC
Active
Other names
Deaconess Family Pharmacy GW
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS FITE (PHARMACY MANAGER)
(812) 450-3784
Entity
Organization
Contact information
Practice address
4209 GATEWAY BLVD., NEWBURGH, IN 47630
(812) 450-3784
Mailing address
600 MARY STREET, EVANSVILLE, IN 47747
(812) 450-3784
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568469
NCPDP
—
Enumeration date
08/28/2017
Last updated
08/28/2017
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