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General NPI Number Information
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NPI Number | 1407095144
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Entity Type | Organization
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Legal Business Name | CALIFORNIA STATE UNIVERSITY LOS ANGELES STUDENT HEALTH CTR. PHARMACY
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 5151 STATE UNIVERSITY DR CSULA STUDENT HEALTH CENTER PHARMACY
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City | LOS ANGELES
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State | CA
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Zip | 90032-4226
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Country | US
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Telephone | 323-343-3300
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Fax | 323-343-3304
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Provider Business Mailing Address
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Address Line | 5151 STATE UNIVERSITY DRIVE CSULA STUDENT HEALTH CENTER PHARMACY
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City | LOS ANGELES
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State | CA
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Zip | 90032
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Country | US
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Telephone | 323-343-3300
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Fax | 323-343-3304
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | DR. GERALD KO
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Credential | PHARM.D
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Telephone | 323-343-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PHE17527
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License Number State | CA
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