Provider Demographics
NPI:1366850117
Name:DEFENSE FINANCE & ACTG SERV
Entity Type:Organization
Organization Name:DEFENSE FINANCE & ACTG SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TAJUDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-544-0347
Mailing Address - Street 1:5462 WHITTLESEY BLVD
Mailing Address - Street 2:APT# 927
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2185
Mailing Address - Country:US
Mailing Address - Phone:850-322-0680
Mailing Address - Fax:
Practice Address - Street 1:7950 MARTIN LOOP
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5648
Practice Address - Country:US
Practice Address - Phone:706-544-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025911261QP2300X, 286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care