Memorial Hospital of South Bend - Team Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MEMORIAL HOSPITAL OF SOUTH BEND - TEAM PHARMACY

Practice address

100 Navarre PL Ste 1150
South Bend, IN 46601-1156

Phone

(574) 647-3534

Fax

(574) 647-6767

NPI assigned

May 30, 2019

Last updated

Feb 12, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

MEMORIAL HOSPITAL OF SOUTH BEND, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey P Costello

Title

Cfo

Phone

(574) 647-3460

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Memorial Hospital of5 organizations share this tax ID, including this one

Part of

Memorial Hospital of

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1033034640
  NPD tax ID
• Memorial Hospital of South Bend

  • Rehabilitation Hospital Unit
  • South Bend, IN
  • NPI 1780564781
  NPD tax ID
• Memorial Hospital of South Bend

  dba Beacon Granger Hospital, A Memorial Hospital Extension

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  NPD tax ID
• Memorial Hospital of South Bend, Inc

  • Physician Assistant
  • South Bend, IN
  • NPI 1134534456
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dusti Ann Yost, PHARMD

  • Pharmacist
  • South Bend, IN
  • NPI 1386159622
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1285292722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 1150",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011156",
            "telephone_number": "574-647-3534",
            "fax_number": "574-647-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 1150",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011156",
            "telephone_number": "574-647-3534",
            "fax_number": "574-647-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL OF SOUTH BEND - TEAM PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL OF SOUTH BEND, INC",
        "enumeration_date": "2019-05-30",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-647-3460"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300029964",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Memorial Home Care, Inc.
• Memorial Hospital
• Memorial Hospital of South Bend
• Memorial Hospital of South Bend (Memorial Epworth Center)
• Memorial Hospital of South Bend
• Memorial Hospital of South Bend, Inc
• Memorial Lighthouse Imaging LLC
• Adelbert J Mencias, MD
• Mackenzie Kathryn Mencias
• Amelia Franchesca Mendez

• Community/Retail Pharmacy in South Bend, IN
• Providers in South Bend, IN by specialty
• Community/Retail Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.