Basic Information
Provider Information
NPI: 1346283140
EntityType: 2
ReplacementNPI:  
OrganizationName: CITY OF HOPE NATL MED CNTR
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CITY OF HOPE PHARMACY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1500 DUARTE RD
Address2:  
City: DUARTE
State: CA
PostalCode: 910103012
CountryCode: US
TelephoneNumber: 6262564673
FaxNumber: 6263018315
Practice Location
Address1: 1500 DUARTE RD
Address2:  
City: DUARTE
State: CA
PostalCode: 910103012
CountryCode: US
TelephoneNumber: 6262564673
FaxNumber: 6263018315
Other Information
ProviderEnumerationDate: 06/13/2006
LastUpdateDate: 06/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KILDOO
AuthorizedOfficialFirstName: CARL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SENIOR DIRECTOR
AuthorizedOfficialTelephone: 6263018833
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: PHARM.D.
NPICertificationDate: 06/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
333600000X  N SuppliersPharmacy 
3336I0012XHSP18518CAY SuppliersPharmacyInstitutional Pharmacy

ID Information
IDTypeStateIssuerDescription
134628314005CA MEDICAID
204045601 PKOTHER


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