Provider Demographics
NPI:1902653223
Name:FEDERAL CORRECTIONAL COMPLEX VICTORVILLE
Entity type:Organization
Organization Name:FEDERAL CORRECTIONAL COMPLEX VICTORVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HUU
Authorized Official - Middle Name:DUYEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:760-530-5700
Mailing Address - Street 1:FEDERAL CORRECTIONAL COMPLEX VICTORVILLE
Mailing Address - Street 2:P.O. BOX 5400
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301
Mailing Address - Country:US
Mailing Address - Phone:760-530-5700
Mailing Address - Fax:
Practice Address - Street 1:FEDERAL CORRECTIONAL COMPLEX VICTORVILLE
Practice Address - Street 2:13777 AIR EXPRESSWAY BLVD.
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394
Practice Address - Country:US
Practice Address - Phone:760-530-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No3336C0002XSuppliersPharmacyClinic Pharmacy