Healthcare Provider Details

I. General information

NPI: 1164433710
Provider Name (Legal Business Name): ST JUDE CHILDREN'S RESEARCH HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

PO BOX 1000 DEPT. 338
MEMPHIS TN
38148-0338
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-2237
  • Fax: 901-595-3111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number843
License Number StateTN

VIII. Authorized Official

Name: WILLIAM HUMPHREY
Title or Position: DIRECTOR
Credential: D PH MS MBA
Phone: 901-595-2233