Provider Demographics
NPI:1730321217
Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO
Other - Org Name:UCSD RESEARCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-543-8080
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MAIL CODE: 8208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-2688
Mailing Address - Fax:619-543-3991
Practice Address - Street 1:220 DICKINSON ST
Practice Address - Street 2:SUITE: A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2071
Practice Address - Country:US
Practice Address - Phone:619-543-2688
Practice Address - Fax:619-543-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44965333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy