Healthcare Provider Details

I. General information

NPI: 1407864374
Provider Name (Legal Business Name): LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BOHANNON DR SUITE 105
MENLO PARK CA
94025-1034
US

IV. Provider business mailing address

4600 BOHANNON DR SUITE 105
MENLO PARK CA
94025-1034
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8316
  • Fax: 650-497-8320
Mailing address:
  • Phone: 650-497-8316
  • Fax: 650-497-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARISA NG
Title or Position: ASST. DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 650-497-8391