DUANE WATERS CORRECTIONAL PHARMACY (NPI# 1770031957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770031957 |
| Entity Type | Organization |
| Organization Name | DUANE WATERS CORRECTIONAL PHARMACY |
| Other Organization Name | PHARMACORR |
| Practice Address |
3857 Cooper St Jackson MI 49201-7547 |
| Practice Telephone | 5177805479 |
| Mailing Telephone | 5177805479 |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2016-09-15 |
| Authorized Official Name | TIMOTHY COURSER (DIRECTOR) |
| Authorized Official Telephone | 5177805474 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2400X |
Clinic/Center Specialization: Prison Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | DEA | FD6016453 | 01 |
| Other Name | Type Code |
|---|---|
| Pharmacorr | Other Name - Individual/Organization |
| Street Address |
3857 COOPER ST |
| City | JACKSON |
| State | MI |
| Zip Code | 49201-7547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104021765 | Lynn M Larson | Internal Medicine | 3857 Cooper St, Jackson, MI 49201-7547 | 2007-06-15 |
| 1215597414 | Matthew Kuiper | Dentist | 3857 Cooper St, Jackson, MI 49201-7547 | 2019-06-19 |
| 1285115931 | Mobile Medical Pros Pllc | Surgery | 3857 Cooper St, Jackson, MI 49201-7547 | 2018-08-21 |
| 1407375207 | Kimberly Lynn Cannon | Nurse Practitioner | 3857 Cooper St, Jackson, MI 49201-7547 | 2017-09-12 |
| 1578913935 | James Michael Mcnamara | Physician Assistant | 3857 Cooper St, Jackson, MI 49201-7547 | 2016-06-16 |
| 1922402429 | Harry Williams | Dentist | 3857 Cooper St, Jackson, MI 49201-7547 | 2014-10-14 |
| 1306272182 | Danielle Sandella Alford | Physician Assistant | 3857 Cooper St, Jackson, MI 49201 | 2013-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174137863 | Sally Ann Shaw | Behavior Technician | 3699 Miles Rd., Jackson, MI 49201 | 2020-09-01 |
| 1780293043 | Alyn Kristin Kay | Technician | Hope Network-hope's Door Cru, 3699 Miles Rd., Jackson, MI 49201 | 2020-07-23 |
| 1841827946 | Maverick Jubane | Student in an Organized Health Care Education/Training Program | Henry Ford Allegiance Health, 205 N East Avenue, Jackson, MI 49201 | 2020-03-26 |
| 1306486584 | Cody Williams | Technician, Other | 1001 Laurence Avenue St E, Jackson, MI 49201 | 2020-01-15 |
| 1720632292 | Krystie Lynn Adorjan | Speech-Language Pathologist | 1175 W Parnall Rd, Jackson, MI 49201 | 2019-08-01 |
| 1407412653 | Howard Franklin Tanner II | Speech-Language Pathologist | 102 East Michigan Avenue, Jackson, MI 49201 | 2019-05-14 |
| 1356863740 | Rima Zarar Qayyum | Speech-Language Pathologist | 4800 Firethorn Dr., Jackson, MI 49201 | 2017-07-07 |
| 1306384383 | Briana Nesmith | Speech-Language Pathologist | 2025 Ann Arbor Road, Jackson, MI 49201 | 2017-02-09 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1306212881 | Aisha Henderson | Social Worker | 729 West Michigan Avenue, Jackson, MI 49201 | 2015-08-19 |
| Find all providers in zip 49201 | ||||
| Taxonomy Code | 261QP2400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Prison Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265687883 | Wayne County Jail Pharmacy | Clinic/Center | 570 Clinton St, Jail Medical, Detroit, MI 48226-2334 | 2008-11-24 |
Please comment or provide details below to improve the information on DUANE WATERS CORRECTIONAL PHARMACY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.