Healthcare Provider Details

I. General information

NPI: 1811014160
Provider Name (Legal Business Name): JAMES RIVER CORRECTIONAL CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 CIRCLE DR
JAMESTOWN ND
58401-6904
US

IV. Provider business mailing address

2521 CIRCLE DR
JAMESTOWN ND
58401-6904
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-3612
  • Fax: 701-253-3666
Mailing address:
  • Phone: 701-253-3612
  • Fax: 701-253-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number584
License Number StateND

VIII. Authorized Official

Name: MR. KENNETH P JOHNSON
Title or Position: PHARMACIST II
Credential: R. PH.
Phone: 701-253-3612