Provider Demographics
NPI:1326069378
Name:UCLA PHARMACY PARENTERAL THRPY
Entity Type:Organization
Organization Name:UCLA PHARMACY PARENTERAL THRPY
Other - Org Name:UCLA HOME INFUSION PCHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHARMCUTICAL SVS
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-206-6555
Mailing Address - Street 1:PO BOX 951695
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:STE 135
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-794-7021
Practice Address - Fax:310-794-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE40977333600000X
3336H0001X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPH0000231Medicaid
0593308OtherOTHER ID NUMBER-COMMERCIAL NUMBER