NPIMap

Organization Active NPI

Lucile Salter Packard Children's Hospital at Stanford

Doing business as a. LPCH Children's Home Pharmacy b. Stanford Home Pharmacy

  • Home Infusion Therapy Pharmacy
  • Menlo Park, CA
National Provider Identifier
1407864374
Registry record updated Aug 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Doing business as
a. LPCH Children's Home Pharmacy b. Stanford Home Pharmacy
Practice address
4600 Bohannon Dr
Suite 105
Menlo Park, CA 94025-1034
Phone
(650) 497-8316
Fax
(650) 497-8320
NPI assigned
Aug 4, 2006
Last updated
Aug 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2019

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

Authorized official

Name
Marisa NG, PHARM.D.
Title
Asst. Director of Pharmacy
Phone
(650) 497-8391

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Therapy Pharmacy 3336H0001X NU Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

4600 Bohannon Dr
Suite 105
Menlo Park, CA 94025-1034

Mailing address

4600 Bohannon Dr
Suite 105
Menlo Park, CA 94025-1034
Phone (650) 497-8316

Other identifiers 5

IdentifierTypeStateIssuer
0549381OtherNABP
FP0549381OtherBLUE SHIELD PHARM
003751OtherBLUE CROSS PROVIDER#
PHA 407800MedicaidCA
ZZZ41694ZOtherBLUE SHIELD HOME INFUSION

Other names 1

  • a. LPCH Children's Home Pharmacy b. Stanford Home Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110310000374 CA DME Supplier - Pharmacy 9436121720 Practice locations: Menlo Park, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lucile Salter Packard Children's Hospital at Stanford12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

2147 Mowry Ave
Fremont, CA 94538
Phone (510) 713-9994

321 Middlefield Rd
Ste 130185140225
Menlo Park, CA 94025
Phone (650) 736-2000

4600 Bohannon Dr
Ste 105
Menlo Park, CA 94025
Phone (650) 497-8316

2495 Hospital Dr
Ste 625
Mountain View, CA 94040
Phone (650) 988-7470

1010 Corporation Way
Palo Alto, CA 94303
Phone (650) 623-3661

1010 Corporation Way
Fl 2
Palo Alto, CA 94303
Phone (650) 623-3661

1101 Welch Rd
Ste B5
Palo Alto, CA 94304
Phone (650) 497-8084

1101 Welch Rd
Ste C1
Palo Alto, CA 94304
Phone (650) 289-0400

1520 Page Mill Rd
Rm 118
Palo Alto, CA 94304
Phone (650) 497-8316

2452 Watson Ct
Ste 1500
Palo Alto, CA 94303
Phone (650) 498-4327

730 Welch Rd
Fl 1
Palo Alto, CA 94304
Phone (650) 497-8263

732 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8376

2900 Whipple Ave
Ste 240
Redwood City, CA 94062
Phone (650) 381-3480

212 San Jose St
Ste 311
Salinas, CA 93901
Phone (831) 759-3265

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1407864374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 BOHANNON DR",
            "address_2": "SUITE 105",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940251034",
            "telephone_number": "650-497-8316",
            "fax_number": "650-497-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 BOHANNON DR",
            "address_2": "SUITE 105",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940251034",
            "telephone_number": "650-497-8316",
            "fax_number": "650-497-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "NG",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "ASST. DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "650-497-8391",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "0549381",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PHARM",
            "identifier": "FP0549381",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER#",
            "identifier": "003751",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA 407800",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD HOME INFUSION",
            "identifier": "ZZZ41694Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "a. LPCH Children's Home Pharmacy b. Stanford Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "a. LPCH Children's Home Pharmacy b. Stanford Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menlo Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.