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General NPI Number Information
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NPI Number | 1093102162
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Entity Type | Organization
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Legal Business Name | SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1915 LAKE AVE
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City | PLYMOUTH
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State | IN
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Zip | 46563-9366
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Country | US
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Telephone | 574-948-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 CITY WEST PKWY
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3248
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Country | US
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Telephone | 952-653-2525
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | CAROL TINCHER
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Credential | PHARM D
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Telephone | 574-948-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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