Provider Demographics
NPI:1811229966
Name:US DEPT OF JUSTICE
Entity Type:Organization
Organization Name:US DEPT OF JUSTICE
Other - Org Name:FEDERAL CORRECTIONAL INSTITUTION EL RENO, OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-319-7519
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-1000
Mailing Address - Country:US
Mailing Address - Phone:405-319-7519
Mailing Address - Fax:405-319-7680
Practice Address - Street 1:4205 E HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9701
Practice Address - Country:US
Practice Address - Phone:405-319-7519
Practice Address - Fax:405-319-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-31
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3726075OtherNCPDP PROVIDER IDENTIFICATION NUMBER