Provider Demographics
NPI:1609906684
Name:UNIVERSITY OF CALIFORNIA RIVERSIDE
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA RIVERSIDE
Other - Org Name:CAMPUS HEALTH CENTER, UNIVERSITY OF CALIFORNIA, RIVERSIDE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:951-827-3926
Mailing Address - Street 1:900 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92521-0001
Mailing Address - Country:US
Mailing Address - Phone:951-827-3031
Mailing Address - Fax:951-827-3133
Practice Address - Street 1:388 W LINDEN ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-827-3926
Practice Address - Fax:951-827-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health