Provider Demographics
NPI:1124138243
Name:NC STATE UNIVERSITY STUDENT HEALTH
Entity type:Organization
Organization Name:NC STATE UNIVERSITY STUDENT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-513-3276
Mailing Address - Street 1:7304 CAMPUS
Mailing Address - Street 2:2815 CATES AVE
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-7304
Mailing Address - Country:US
Mailing Address - Phone:919-513-3276
Mailing Address - Fax:919-513-0440
Practice Address - Street 1:7304 CAMPUS
Practice Address - Street 2:2815 CATES AVE
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-7304
Practice Address - Country:US
Practice Address - Phone:919-513-3276
Practice Address - Fax:919-513-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3222261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health