Provider Demographics
NPI:1104011667
Name:ATLANTIC CITY USCG PHCY
Entity Type:Organization
Organization Name:ATLANTIC CITY USCG PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER DOD PHARMACY OPS
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:210-221-8443
Mailing Address - Street 1:2450 STANLEY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7510
Mailing Address - Country:US
Mailing Address - Phone:210-221-8443
Mailing Address - Fax:
Practice Address - Street 1:AMELIA EARHART ROAD
Practice Address - Street 2:BLDG 350
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08405-0001
Practice Address - Country:US
Practice Address - Phone:609-677-2028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy