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General NPI Number Information
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NPI Number | 1033719729
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Entity Type | Organization
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Legal Business Name | FCI TALLADEGA
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 565 E. RENFROE ROAD
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City | TELLADEGA
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State | AL
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Zip | 35160
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Country | US
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Telephone | 256-315-4127
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Fax | 256-315-4390
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Provider Business Mailing Address
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Address Line | 565 E. RENFROE ROAD
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City | TELLADEGA
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State | AL
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Zip | 35160
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Country | US
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Telephone | 256-315-4127
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Fax | 256-315-4390
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | DR. CASEY DELANE SUMNER
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Credential | PHARM.D.
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Telephone | 256-315-4127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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