Healthcare Provider Details

I. General information

NPI: 1871164608
Provider Name (Legal Business Name): FCI WASECA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 UNIVERSITY DRIVE SW
WASECA MN
56093-0741
US

IV. Provider business mailing address

1000 UNIVERSITY DRIVE SW
WASECA MN
56093-0741
US

V. Phone/Fax

Practice location:
  • Phone: 507-835-8972
  • Fax:
Mailing address:
  • Phone: 507-835-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE ADAMS
Title or Position: CHIEF PHARMACIST
Credential: PHARMD
Phone: 507-835-8972