Provider Demographics
NPI:1033484886
Name:FEDERAL CORRECTIONAL INSTITUTE
Entity Type:Organization
Organization Name:FEDERAL CORRECTIONAL INSTITUTE
Other - Org Name:FCI MORGANTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-284-4397
Mailing Address - Street 1:446 GREENBAG RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7159
Mailing Address - Country:US
Mailing Address - Phone:304-284-4397
Mailing Address - Fax:304-284-3615
Practice Address - Street 1:446 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7159
Practice Address - Country:US
Practice Address - Phone:304-284-4397
Practice Address - Fax:304-284-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5055644OtherNCPDP PROVIDER IDENTIFICATION NUMBER