MEDICARE: CALIFORNIA STATE UNIVERSITY LOS ANGELES STUDENT HEALTH CTR. 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	3336C0002X	Clinic Pharmacy	PHE17527	CA

General Provider Information

NPI Number	:	1407095144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA STATE UNIVERSITY LOS ANGELES STUDENT HEALTH CTR. PHARMACY

Provider Business Mailing Address
First Line	:	5151 STATE UNIVERSITY DRIVE
Second Line	:	CSULA STUDENT HEALTH CENTER PHARMACY
City	:	LOS ANGELES
State	:	CA
Zip	:	90032
Country	:	US
Telephone Number	:	323-343-3300
Fax Number	:	323-343-3304

Provider Business Practice Location Address
First Line	:	5151 STATE UNIVERSITY DR
Second Line	:	CSULA STUDENT HEALTH CENTER PHARMACY
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-4226
Country	:	US
Telephone Number	:	323-343-3300
Fax Number	:	323-343-3304

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	DR. GERALD KO
Credential	:	PHARM.D
Telephone Number	:	323-343-3300

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/21/2024

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Practice Location Address:

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