Provider Demographics
NPI:1801838370
Name:UNC-CH STUDENT HEALTH SERVICE
Entity Type:Organization
Organization Name:UNC-CH STUDENT HEALTH SERVICE
Other - Org Name:CAMPUS HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-966-9176
Mailing Address - Street 1:CB 7470 JAMES A TAYLOR BUILDING
Mailing Address - Street 2:EMERGENCY DRIVE ROOM 3
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7470
Mailing Address - Country:US
Mailing Address - Phone:919-966-6556
Mailing Address - Fax:919-966-6431
Practice Address - Street 1:320 EMERGENCY RM DRIVE JAMES A TAYLOR BUILDING
Practice Address - Street 2:EMERGENCY DRIVE
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7470
Practice Address - Country:US
Practice Address - Phone:919-966-6556
Practice Address - Fax:919-966-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC030253336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070270OtherPK
NC1801838370Medicaid