Provider Demographics
NPI:1700507548
Name:FCI GILMER
Entity Type:Organization
Organization Name:FCI GILMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-626-2549
Mailing Address - Street 1:201 FCI LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-9500
Mailing Address - Country:US
Mailing Address - Phone:304-626-2549
Mailing Address - Fax:
Practice Address - Street 1:201 FCI LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-9500
Practice Address - Country:US
Practice Address - Phone:304-626-2549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No3336C0002XSuppliersPharmacyClinic Pharmacy