Provider Demographics
NPI:1073602629
Name:USC SCHOOL OF PHARMACY
Entity Type:Organization
Organization Name:USC SCHOOL OF PHARMACY
Other - Org Name:USC VERDUGO HILLS PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:SVADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-442-6121
Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:818-952-2223
Mailing Address - Fax:818-952-4760
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:STE 111
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-952-2223
Practice Address - Fax:818-952-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY515643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141882OtherPK
CANONEMedicaid