Provider Demographics
NPI:1922470053
Name:UCSD STUDENT HEALTH SERVICE PHARMACY
Entity Type:Organization
Organization Name:UCSD STUDENT HEALTH SERVICE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:858-534-2135
Mailing Address - Street 1:9500 GILMAN DRIVE, MAIL CODE 0039
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0039
Mailing Address - Country:US
Mailing Address - Phone:858-534-2135
Mailing Address - Fax:858-534-0814
Practice Address - Street 1:9500 GILMAN DR DEPT 39
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0039
Practice Address - Country:US
Practice Address - Phone:858-534-2135
Practice Address - Fax:858-534-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH27876261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health