Provider Demographics
NPI:1043625981
Name:JAMES A LOVELL FHCC
Entity Type:Organization
Organization Name:JAMES A LOVELL FHCC
Other - Org Name:DOD GREAT LAKES BURKEY MALL EPHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
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:PO BOX 322
Mailing Address - Street 2:JAMES A LOVELL FHCC
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:224-610-4232
Mailing Address - Fax:
Practice Address - Street 1:2630 GREEN BAY RD BLDG 3452
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60088-3303
Practice Address - Country:US
Practice Address - Phone:847-688-2772
Practice Address - Fax:847-688-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146521OtherPK