Provider Demographics
NPI:1548308539
Name:UNIVERSITY OF CALIFORNIA RIVERSIDE
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA RIVERSIDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:951-827-3926
Mailing Address - Street 1:CAMPUS HEALTH CENTER PHARMACY
Mailing Address - Street 2:388 W LINDEN ST
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0001
Mailing Address - Country:US
Mailing Address - Phone:951-827-4202
Mailing Address - Fax:951-827-5829
Practice Address - Street 1:388 W LINDEN ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0001
Practice Address - Country:US
Practice Address - Phone:951-827-3926
Practice Address - Fax:951-827-5829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA, RIVERSIDE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1835P2201X
CAPHE455783336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0564395OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHE59214OtherPHARMACY LICENSE