Provider Demographics
NPI:1225376577
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:SVADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-632-0505
Mailing Address - Street 1:1025 WEST 34TH STREET (KOH) STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0046
Mailing Address - Country:US
Mailing Address - Phone:213-821-6100
Mailing Address - Fax:
Practice Address - Street 1:1025 WEST 34TH STREET (KOH) STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0028
Practice Address - Country:US
Practice Address - Phone:213-740-2738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5646356OtherNCPDP PROVIDER IDENTIFICATION NUMBER