Provider Demographics
NPI:1750524831
Name:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO AP
Entity type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO AP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:ARGUIJO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-537-3273
Mailing Address - Street 1:5500 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2318
Mailing Address - Country:US
Mailing Address - Phone:909-537-3273
Mailing Address - Fax:909-537-7768
Practice Address - Street 1:5500 UNIVERSITY PKWY
Practice Address - Street 2:STUDENT HEALTH CENTER PHARMACY
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2318
Practice Address - Country:US
Practice Address - Phone:909-537-3273
Practice Address - Fax:909-537-7768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X
CA19584333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168661OtherPK