Provider Demographics
NPI:1073603304
Name:NAVAL HEALTH CLINIC NEW ENGLAND
Entity Type:Organization
Organization Name:NAVAL HEALTH CLINIC NEW ENGLAND
Other - Org Name:DOD GROTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA POSC
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:NAVAL BRANCH HEALTH CLINIC GROTON
Mailing Address - Street 2:1 WAHOO AVE
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:BUILDING 449
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-2324
Practice Address - Country:US
Practice Address - Phone:888-628-9633
Practice Address - Fax:860-694-2367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC NEW ENGLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002351OtherPK