=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902196504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHFIELD HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2011
-----------------------------------------------------
Last Update Date | 10/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 NORTH AVE
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-1498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-646-1168
-----------------------------------------------------
Fax | 507-646-1169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 NORTH AVE ATTN: PHARMACY DEPARTMENT
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-1498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-646-1168
-----------------------------------------------------
Fax | 507-646-1169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | GARY ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-646-1171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | 200537
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------