Healthcare Provider Details

I. General information

NPI: 1346699709
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: 06/07/2016
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BOHANNON DR # 120
MENLO PARK CA
94025-1034
US

IV. Provider business mailing address

4600 BOHANNON DR # 120
MENLO PARK CA
94025-1034
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8289
  • Fax: 650-497-8974
Mailing address:
  • Phone: 650-497-8289
  • Fax: 650-497-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WONG
Title or Position: PHARMACY MANAGER
Credential:
Phone: 650-497-8289