Provider Demographics
NPI:1508538679
Name:FCI JESUP
Entity Type:Organization
Organization Name:FCI JESUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-0870
Mailing Address - Street 1:2600 HIGHWAY 301 SOUTH
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31599-0001
Mailing Address - Country:US
Mailing Address - Phone:912-427-0870
Mailing Address - Fax:
Practice Address - Street 1:2600 HIGHWAY 301 SOUTH
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31599-0001
Practice Address - Country:US
Practice Address - Phone:912-427-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No3336C0002XSuppliersPharmacyClinic Pharmacy