Healthcare Provider Details

I. General information

NPI: 1154651784
Provider Name (Legal Business Name): UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVE # 2407
LOS ANGELES CA
90089-0112
US

IV. Provider business mailing address

1441 EASTLAKE AVE # 2407
LOS ANGELES CA
90089-0112
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-3000
  • Fax: 323-865-3868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD R. DICKEY
Title or Position: SEN. VP ADMINISTRATION
Credential: JD
Phone: 213-740-7922