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General NPI Number Information
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NPI Number | 1700507548
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Entity Type | Organization
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Legal Business Name | FCI GILMER
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 201 FCI LN
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City | GLENVILLE
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State | WV
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Zip | 26351-9500
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Country | US
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Telephone | 304-626-2549
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Fax |
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Provider Business Mailing Address
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Address Line | 201 FCI LN
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City | GLENVILLE
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State | WV
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Zip | 26351-9500
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Country | US
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Telephone | 304-626-2549
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Fax |
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | MACY NICHOLE GREGORY
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Credential | PHARMD
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Telephone | 304-626-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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