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	3336C0002X	Clinic Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY 51725	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2144750	OTHER		PK

General Provider Information

NPI Number	:	1306263264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF SOUTHERN CALIFORNIA

Provider Business Mailing Address
First Line	:	PO BOX 33227
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-0227
Country	:	US
Telephone Number	:	323-442-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 S FLOWER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4608
Country	:	US
Telephone Number	:	213-486-8652
Fax Number	:	323-865-9364

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	CAROLINE CHELLAMY
Credential	:	PHARMD
Telephone Number	:	323-865-3545

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	06/23/2014

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