1407877483 NPI number — REGENTS OF THE UNIVERSITY OF CA-UCSD AMBULATORY CARE PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407877483 NPI number — REGENTS OF THE UNIVERSITY OF CA-UCSD AMBULATORY CARE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF CA-UCSD AMBULATORY CARE PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UCSD MEDICAL GROUP PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407877483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W ARBOR DR
Provider Second Line Business Mailing Address:
MAIL CODE 8765
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-6194
Provider Business Mailing Address Fax Number:
619-543-5829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 LEWIS ST
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-471-9235
Provider Business Practice Location Address Fax Number:
619-471-9236
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAGNEY
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR UCSD AMCARE PHARMACY
Authorized Official Telephone Number:
619-543-6194

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHE37896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X , with the licence number: PHE37896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHE37896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0546412 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: GU028B . This is a "MEDICARE PART B" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHB378960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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