Basic Information
| Provider Information | |||||||||
| NPI: | 1710350384 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH KERN STATE PRISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2737 WEST CECIL AVE | ||||||||
| Address2: | |||||||||
| City: | DELANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617212345 | ||||||||
| FaxNumber: | 6617216252 | ||||||||
| Practice Location | |||||||||
| Address1: | 2737 WEST CECIL AVE | ||||||||
| Address2: | |||||||||
| City: | DELANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617212345 | ||||||||
| FaxNumber: | 6617216252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2015 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | SPIEGEL | ||||||||
| AuthorizedOfficialFirstName: | BETH | ||||||||
| AuthorizedOfficialMiddleName: | CARON | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACIST IN CHARGE | ||||||||
| AuthorizedOfficialTelephone: | 6617216269 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHARM.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2400X | LCF39290 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
No ID Information.