Provider Demographics
NPI:1568613255
Name:STUDENT HEALTH SERVICES PHCY, CA STATE UNIVERSITY CHICO
Entity Type:Organization
Organization Name:STUDENT HEALTH SERVICES PHCY, CA STATE UNIVERSITY CHICO
Other - Org Name:STUDENT HEALTH SVC PHY-CA ST UNIV CHICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-898-3044
Mailing Address - Street 1:400 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95929-0001
Mailing Address - Country:US
Mailing Address - Phone:530-898-3044
Mailing Address - Fax:530-898-6731
Practice Address - Street 1:601 WARNER STR ROOM 152
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0001
Practice Address - Country:US
Practice Address - Phone:530-898-6068
Practice Address - Fax:530-898-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE40672333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5633359OtherNCPDP PROVIDER IDENTIFICATION NUMBER