Provider Demographics
NPI:1598773566
Name:UNIVERSITY RX SPECIALISTS, INC
Entity Type:Organization
Organization Name:UNIVERSITY RX SPECIALISTS, INC
Other - Org Name:UNIVERSITY COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-238-9502
Mailing Address - Street 1:1875 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101
Mailing Address - Country:US
Mailing Address - Phone:619-683-2005
Mailing Address - Fax:619-683-2008
Practice Address - Street 1:1875 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:619-683-2005
Practice Address - Fax:619-683-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40868183500000X
CAPHY45621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA456210Medicaid
CAPHY45621OtherPHARMACY LICENSE
CABU7932165OtherPHARMACY DEA