# STATE OF CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** STUDENT HLTH SRVC CSU LONG BCH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639190606
- **Authorized official:** KATHY CHEN (PHARMACY MANAGER)
- **Authorized official phone:** (562) 985-1561

## Contact information

- **Practice address:** 1250 N BELLFLOWER BLVD, LONG BEACH, CA 90840-0004
- **Practice address phone:** (562) 985-1561
- **Practice address fax:** (562) 985-8404
- **Mailing address:** 1250 N BELLFLOWER BLVD, LONG BEACH, CA 90840-0004
- **Mailing address phone:** (562) 985-1561
- **Mailing address fax:** (562) 985-8404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | — | — |
| 3336I0012X | Institutional Pharmacy | PHE14217 | CA | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 04/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0534974 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 142170 | — | CA |