MEDICARE: UNIVERSITY OF SOUTHERN CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1154651784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF SOUTHERN CALIFORNIA

Provider Business Mailing Address
First Line	:	1441 EASTLAKE AVE
Second Line	:	# 2407
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 EASTLAKE AVE
Second Line	:	# 2407
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0112
Country	:	US
Telephone Number	:	323-865-3000
Fax Number	:	323-865-3868

Authorized Official
Title or Position	:	SEN. VP ADMINISTRATION
Name	:	MR. TODD R. DICKEY
Credential	:	JD
Telephone Number	:	213-740-7922

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	01/04/2010

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