Provider Demographics
NPI:1558435784
Name:UNIVERSITY HEALTH CENTER, UNIVERSITY OF GA HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH CENTER, UNIVERSITY OF GA HEALTH CENTER PHARMACY
Other - Org Name:UNIVERSITY OF GEORGIA HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-542-9979
Mailing Address - Street 1:55 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1755
Mailing Address - Country:US
Mailing Address - Phone:706-542-9979
Mailing Address - Fax:706-583-0276
Practice Address - Street 1:55 CARLTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1755
Practice Address - Country:US
Practice Address - Phone:706-542-9979
Practice Address - Fax:706-583-0276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD42052Medicare UPIN
GAG00727Medicare UPIN
GAP08133Medicare UPIN
GAD39590Medicare UPIN
GAG19133Medicare UPIN
GAP57704Medicare UPIN
GAD41025Medicare UPIN
GAG27079Medicare UPIN
GAC85985Medicare UPIN
GAD42279Medicare UPIN
GAF27230Medicare UPIN
GAP05301Medicare UPIN
GAD46265Medicare UPIN
GAR94550Medicare UPIN