MEDICARE: PHARMERICA HOSPITAL PHARMACY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	1-5531	OK

General Provider Information

NPI Number	:	1508177767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMERICA HOSPITAL PHARMACY SERVICES, INC.

Provider Business Mailing Address
First Line	:	1901 CAMPUS PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2308
Country	:	US
Telephone Number	:	502-627-7552
Fax Number	:	502-261-2437

Provider Business Practice Location Address
First Line	:	8210 NATIONAL AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-8518
Country	:	US
Telephone Number	:	405-739-0800
Fax Number	:	405-739-6480

Authorized Official
Title or Position	:	PRESIDENT OF HOSPITAL DIVISION
Name	:	MR. WILLIAM T. LADEMANN JR.
Credential	:	RPH, MS, MBA
Telephone Number	:	502-627-7552

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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