Provider Demographics
NPI:1093176976
Name:FEDERAL CORRECTIONAL INSTITUTION SHERIDAN
Entity Type:Organization
Organization Name:FEDERAL CORRECTIONAL INSTITUTION SHERIDAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-843-6446
Mailing Address - Street 1:27072 SW BALLSTON RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-9620
Mailing Address - Country:US
Mailing Address - Phone:503-843-6446
Mailing Address - Fax:503-843-6657
Practice Address - Street 1:27072 SW BALLSTON RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-9620
Practice Address - Country:US
Practice Address - Phone:503-843-6446
Practice Address - Fax:503-843-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare