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General NPI Number Information
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NPI Number | 1629470612
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Entity Type | Organization
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Legal Business Name | AUBURN CORRECTIONAL FCLTY-PHCY
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 135 STATE ST
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City | AUBURN
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State | NY
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Zip | 13024-9001
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Country | US
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Telephone | 315-253-8401
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Fax | 315-255-1371
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Provider Business Mailing Address
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Address Line | 135 STATE ST
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City | AUBURN
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State | NY
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Zip | 13024-9001
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Country | US
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Telephone | 315-253-8401
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Fax | 315-255-1371
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Authorized Official
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Title or Position | SUPERVISING RPH III
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Name | GRACE ELLEGATE
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Credential |
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Telephone | 315-253-8401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 010267
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License Number State | NY
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