Organization
REGENTS OF THE UNIVERSITY OF CALIFORNIA-UCSD AMBULATORY CARE PHARMACY
Active
Parent organization
REGENTS OF THE UNIVERSITY OF CALIFORNIA-UCSDMG
Other names
UCSD IMG CLINIC PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
REGENTS OF THE UNIVERSITY OF CALIFORNIA-UCSDMG
Authorized official
MR. GARY HAGNEY RPH (DIRECTOR UCSD AMCARE PHARMACY)
(619) 543-6194
Entity
Organization
Contact information
Practice address
8939 VILLA LA JOLLA DR, STE 129, LA JOLLA, CA 92037-1732
(858) 657-2220
(858) 657-2228
Mailing address
200 W ARBOR DR, MAIL CODE 8765, SAN DIEGO, CA 92103-9001
(619) 543-6194
(619) 543-5829
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHE48990
CA
3336C0002X
Clinic Pharmacy
PHE48990
CA
3336C0003X
Community/Retail Pharmacy
PHE48990
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5629499
NCPDP
CA
01
—
GZ617A
MEDICARE PART B
CA
Enumeration date
03/04/2008
Last updated
06/10/2013
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