Provider Demographics
NPI:1912929407
Name:SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER
Other - Org Name:LLUMC OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-558-5075
Mailing Address - Street 1:11234 ANDERSON ST RM 1147
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-5075
Mailing Address - Fax:909-558-8773
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4500
Practice Address - Fax:909-558-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY509733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0555093OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHB137960Medicaid
CAPHB137960Medicaid