Healthcare Provider Details

I. General information

NPI: 1750524831
Provider Name (Legal Business Name): CALIFORNIA STATE UNIVERSITY SAN BERNARDINO AP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 UNIVERSITY PKWY STUDENT HEALTH CENTER PHARMACY
SAN BERNARDINO CA
92407-2318
US

IV. Provider business mailing address

5500 UNIVERSITY PKWY
SAN BERNARDINO CA
92407-2318
US

V. Phone/Fax

Practice location:
  • Phone: 909-537-3273
  • Fax: 909-537-7768
Mailing address:
  • Phone: 909-537-3273
  • Fax: 909-537-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number19584
License Number StateCA

VIII. Authorized Official

Name: DR. ABIGAIL PEREZ ARGUIJO
Title or Position: PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 909-537-3273