{
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"OrgName": "CALIFORNIA STATE UNIVERSITY LOS ANGELES STUDENT HEALTH CTR. PHARMACY",
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"FirstLineMailingAddress": "5151 STATE UNIVERSITY DRIVE",
"SecondLineMailingAddress": "CSULA STUDENT HEALTH CENTER PHARMACY",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90032",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-343-3300",
"MailingAddressFaxNumber": "323-343-3304",
"FirstLinePracticeLocationAddress": "5151 STATE UNIVERSITY DR",
"SecondLinePracticeLocationAddress": "CSULA STUDENT HEALTH CENTER PHARMACY",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90032-4226",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "323-343-3300",
"PracticeLocationAddressFaxNumber": "323-343-3304",
"EnumerationDate": "02/19/2009",
"LastUpdateDate": "02/21/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KO",
"AuthorizedOfficialFirstName": "GERALD",
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"AuthorizedOfficialTitle": "DIRECTOR OF PHARMACY",
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"AuthorizedOfficialCredential": "PHARM.D",
"AuthorizedOfficialTelephoneNumber": "323-343-3300",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "PHE17527",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}