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General NPI Number Information
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NPI Number | 1902375033
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Entity Type | Organization
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Legal Business Name | UNITED STATES PENITENTIARY
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 2400 ROBERT F. MILLER DRIVE
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City | LEWISBURG
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State | PA
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Zip | 17837
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Country | US
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Telephone | 570-523-1251
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 ROBERT F. MILLER DRIVE
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City | LEWISBURG
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State | PA
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Zip | 17837
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Country | US
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Telephone | 570-523-1251
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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 | REGINA M. BROWN
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Credential |
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Telephone | 570-523-1251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number |
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License Number State |
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