Provider Demographics
NPI:1114081866
Name:WALTER REED NATIONAL MILITARY MED CENTER
Entity Type:Organization
Organization Name:WALTER REED NATIONAL MILITARY MED CENTER
Other - Org Name:CARLISLE DUNHAM CALL-IN PHCY
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 1:450 GIBNER RD
Mailing Address - Street 2:2480 LLEWELLYN AVE STE 5800
Mailing Address - City:CARLISLE BARRACKS
Mailing Address - State:PA
Mailing Address - Zip Code:17013-5090
Mailing Address - Country:US
Mailing Address - Phone:717-245-3852
Mailing Address - Fax:717-245-3815
Practice Address - Street 1:450 GIBNER RD
Practice Address - Street 2:
Practice Address - City:CARLISLE BARRACKS
Practice Address - State:PA
Practice Address - Zip Code:17013-5090
Practice Address - Country:US
Practice Address - Phone:717-245-3852
Practice Address - Fax:717-245-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085494OtherPK