Provider Demographics
NPI:1346302403
Name:QUANTICO SPECIAL ORDER PHCY
Entity Type:Organization
Organization Name:QUANTICO SPECIAL ORDER PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS CENTER MGR
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:NMC 2200 LESTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134
Mailing Address - Country:US
Mailing Address - Phone:703-784-1579
Mailing Address - Fax:703-784-1579
Practice Address - Street 1:NMC 2200 LESTER AVENUE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134
Practice Address - Country:US
Practice Address - Phone:703-784-1579
Practice Address - Fax:703-784-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy