Provider Demographics
NPI:1225376577
Name:USC HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:USC HEALTH CENTER PHARMACY
Other - Org Name:USC HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-746-3791
Mailing Address - Street 1:3601 TROUSDALE PKWY # 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0046
Mailing Address - Country:US
Mailing Address - Phone:213-740-2738
Mailing Address - Fax:
Practice Address - Street 1:1150 W JEFFERSON BLVD
Practice Address - Street 2:(PSB) STE 150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0028
Practice Address - Country:US
Practice Address - Phone:213-740-2738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5646356OtherNCPDP PROVIDER IDENTIFICATION NUMBER