Provider Demographics
NPI:1871164608
Name:FCI WASECA
Entity type:Organization
Organization Name:FCI WASECA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:507-835-8972
Mailing Address - Street 1:1000 UNIVERSITY DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-0741
Mailing Address - Country:US
Mailing Address - Phone:507-835-8972
Mailing Address - Fax:
Practice Address - Street 1:1000 UNIVERSITY DRIVE SW
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-0741
Practice Address - Country:US
Practice Address - Phone:507-835-8972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No3336C0002XSuppliersPharmacyClinic Pharmacy