Provider Demographics
NPI:1467864009
Name:NAVAL HEALTH CLINIC LEMOORE
Entity Type:Organization
Organization Name:NAVAL HEALTH CLINIC LEMOORE
Other - Org Name:DOD FALLON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA POSC
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 1:4755 PASTURE RD
Mailing Address - Street 2:BLDG 299
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89496-5000
Mailing Address - Country:US
Mailing Address - Phone:775-426-3122
Mailing Address - Fax:775-426-3134
Practice Address - Street 1:4755 PASTURE RD BLDG 299
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89496-5000
Practice Address - Country:US
Practice Address - Phone:775-426-3122
Practice Address - Fax:775-426-3134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC LEMOORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-02
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146011OtherPK