=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356352918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUSTEES OF COLUMBIA UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 05/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 161 FT WASHINGTN AVE IP 749
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-8684
-----------------------------------------------------
Fax | 212-305-0397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 FT WASHINGTN AVE IP 749
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-8684
-----------------------------------------------------
Fax | 212-305-0397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CPMC RSCH PHCY
-----------------------------------------------------
Name | ROBERT MACAUTHUR
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 212-305-8684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | 023275
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------