Provider Demographics
NPI:1326145178
Name:LACKLAND NCFC PHCY
Entity Type:Organization
Organization Name:LACKLAND NCFC PHCY
Other - Org Name:LACKLAND NCFC PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR PHRMCY OPERATIONS CNTR
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:210-221-8443
Mailing Address - Street 1:2200 BERGQUIST DR STE 1
Mailing Address - Street 2:BLDG 4450
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:BLDG 4450
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5410
Practice Address - Fax:210-292-3722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LACKLAND NCFC PHCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4511805OtherOTHER ID NUMBER-COMMERCIAL NUMBER