Healthcare Provider Details

I. General information

NPI: 1649637794
Provider Name (Legal Business Name): VANDERBILT UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 21ST AVE S ROOM 1006
NASHVILLE TN
37232-0014
US

IV. Provider business mailing address

726 MELROSE AVE
NASHVILLE TN
37211-2151
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-1040
  • Fax: 615-936-2289
Mailing address:
  • Phone: 615-936-1040
  • Fax: 615-936-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK SULLIVAN
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 615-343-9595