Provider Demographics
NPI:1790160273
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:KECK MEDICINE OF USC SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & CEO, KECK MEDICINE OF USC
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-885-2600
Mailing Address - Street 1:1000 S FREMONT AVE
Mailing Address - Street 2:SUITE 10150
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8800
Mailing Address - Country:US
Mailing Address - Phone:855-885-2600
Mailing Address - Fax:626-457-4195
Practice Address - Street 1:1000 S FREMONT AVE
Practice Address - Street 2:SUITE 10150
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:855-885-2600
Practice Address - Fax:626-457-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy