Provider Demographics
NPI:1588414049
Name:INDIAN RIVER MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:INDIAN RIVER MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GOWANS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:754-243-4121
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-290-6970
Mailing Address - Fax:772-290-6971
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-290-6970
Practice Address - Fax:772-290-6971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIAN RIVER MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy