Provider Demographics
NPI:1407095144
Name:CALIFORNIA STATE UNIVERSITY LOS ANGELES STUDENT HEALTH CTR. PHARMACY
Entity Type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY LOS ANGELES STUDENT HEALTH CTR. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-343-3300
Mailing Address - Street 1:5151 STATE UNIVERSITY DRIVE
Mailing Address - Street 2:CSULA STUDENT HEALTH CENTER PHARMACY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032
Mailing Address - Country:US
Mailing Address - Phone:323-343-3300
Mailing Address - Fax:323-343-3304
Practice Address - Street 1:5151 STATE UNIVERSITY DR
Practice Address - Street 2:CSULA STUDENT HEALTH CENTER PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-4226
Practice Address - Country:US
Practice Address - Phone:323-343-3300
Practice Address - Fax:323-343-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE175273336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy