Provider Demographics
NPI:1497368369
Name:FEDERAL BUREAU OF PRISONS
Entity Type:Organization
Organization Name:FEDERAL BUREAU OF PRISONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-765-4482
Mailing Address - Street 1:1000 AIRBASE RD.
Mailing Address - Street 2:
Mailing Address - City:POLLOCK
Mailing Address - State:LA
Mailing Address - Zip Code:71467-3521
Mailing Address - Country:US
Mailing Address - Phone:318-765-4482
Mailing Address - Fax:318-765-4459
Practice Address - Street 1:1000 AIRBASE RD.
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467-3521
Practice Address - Country:US
Practice Address - Phone:318-765-4482
Practice Address - Fax:318-765-4459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health