Healthcare Provider Details

I. General information

NPI: 1033484886
Provider Name (Legal Business Name): FEDERAL CORRECTIONAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 GREENBAG RD
MORGANTOWN WV
26501-7159
US

IV. Provider business mailing address

446 GREENBAG RD
MORGANTOWN WV
26501-7159
US

V. Phone/Fax

Practice location:
  • Phone: 304-284-4397
  • Fax: 304-284-3615
Mailing address:
  • Phone: 304-284-4397
  • Fax: 304-284-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAMI RODRIGUEZ
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 304-284-4397