Healthcare Provider Details

I. General information

NPI: 1497368369
Provider Name (Legal Business Name): FEDERAL BUREAU OF PRISONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AIRBASE RD.
POLLOCK LA
71467-3521
US

IV. Provider business mailing address

1000 AIRBASE RD.
POLLOCK LA
71467-3521
US

V. Phone/Fax

Practice location:
  • Phone: 318-765-4482
  • Fax: 318-765-4459
Mailing address:
  • Phone: 318-765-4482
  • Fax: 318-765-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLIE WILLIAMS
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 318-765-4482