Provider Demographics
NPI:1952515801
Name:HUMBOLDT STATE UNIVERSITY
Entity Type:Organization
Organization Name:HUMBOLDT STATE UNIVERSITY
Other - Org Name:STUDENT HEALTH CENTER PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSODIRECTOR, STUDENT HEALTH CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:VANCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-826-5019
Mailing Address - Street 1:1 HARPST ST
Mailing Address - Street 2:BUILDING 42
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-8222
Mailing Address - Country:US
Mailing Address - Phone:707-826-3146
Mailing Address - Fax:707-826-5042
Practice Address - Street 1:1 HARPST ST
Practice Address - Street 2:BUILDING 42
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-8222
Practice Address - Country:US
Practice Address - Phone:707-826-3146
Practice Address - Fax:707-826-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLE 1688261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health