Provider Demographics
NPI:1033506431
Name:NAVAL HOSPITAL CAMP PENDLETON
Entity Type:Organization
Organization Name:NAVAL HOSPITAL CAMP PENDLETON
Other - Org Name:DOD PT HUENEME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:34520 BOB WILSON DR
Mailing Address - Street 2:STE 20
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-2098
Mailing Address - Country:US
Mailing Address - Phone:619-532-8400
Mailing Address - Fax:
Practice Address - Street 1:162 1ST ST BLDG 1402
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043
Practice Address - Country:US
Practice Address - Phone:805-982-6411
Practice Address - Fax:805-982-6095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL CAMP PENDLETON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-23
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151514OtherPK