Provider Demographics
NPI:1275849937
Name:GAHACC
Entity Type:Organization
Organization Name:GAHACC
Other - Org Name:DRUM WTU PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR PHARMACY OPS CTR
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:EUPHRATES RIVER VALLEY ROAD
Mailing Address - Street 2:BLDG 10506
Mailing Address - City:FT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602
Mailing Address - Country:US
Mailing Address - Phone:315-772-8400
Mailing Address - Fax:315-772-5953
Practice Address - Street 1:EUPHRATES RIVER VALLEY ROAD
Practice Address - Street 2:BLDG 10506
Practice Address - City:FT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:315-772-8400
Practice Address - Fax:315-772-5953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAHACC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy