MEDICARE: UCI STUDENT HEALTH CENTER PHARMACY

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	183500000X	Pharmacist	PHE35938	CA

General Provider Information

NPI Number	:	1194897520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCI STUDENT HEALTH CENTER PHARMACY

Provider Business Mailing Address
First Line	:	501 STUDENT HEALTH CENTER DR
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92697-5200
Country	:	US
Telephone Number	:	949-824-1440
Fax Number	:	949-824-3666

Provider Business Practice Location Address
First Line	:	501 STUDENT HEALTH CENTER DR
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92697-5200
Country	:	US
Telephone Number	:	949-824-1440
Fax Number	:	949-824-3666

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	DR. JOHN T SHIOYA
Credential	:	PHARM D
Telephone Number	:	949-824-2643

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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