Provider Demographics
NPI:1154651784
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:USC I.D.S. PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEN. VP ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:213-740-7922
Mailing Address - Street 1:1441 EASTLAKE AVE
Mailing Address - Street 2:# 2407
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:# 2407
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3000
Practice Address - Fax:323-865-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy