Provider Demographics
NPI:1811016488
Name:CALIFORNIA STATE UNIVERSITY BAKERSFIELD
Entity Type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY BAKERSFIELD
Other - Org Name:CALIFORNIA STATE COLLEGE BAKERSFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:661-654-3304
Mailing Address - Street 1:9001 STOCKDALE HWY
Mailing Address - Street 2:28HC
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1022
Mailing Address - Country:US
Mailing Address - Phone:661-654-3304
Mailing Address - Fax:661-654-2573
Practice Address - Street 1:9001 STOCKDALE HWY
Practice Address - Street 2:28HC
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1022
Practice Address - Country:US
Practice Address - Phone:661-654-3304
Practice Address - Fax:661-654-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHE195923336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002042OtherPK