Provider Demographics
NPI:1497163679
Name:WRIGHT-PATTERSON MEDICAL CENTER
Entity Type:Organization
Organization Name:WRIGHT-PATTERSON MEDICAL CENTER
Other - Org Name:DOD WRIGHT PATTERSON KITTYHAWK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
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:WRIGHT-PATTERSON MEDICAL CENTER
Mailing Address - Street 2:4881 SUGAR MAPLE DR.
Mailing Address - City:WRIGHT PAT
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5546
Mailing Address - Country:US
Mailing Address - Phone:937-656-1656
Mailing Address - Fax:937-656-1516
Practice Address - Street 1:2130 SYCAMORE ST STE 1
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5461
Practice Address - Country:US
Practice Address - Phone:937-656-1656
Practice Address - Fax:937-656-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147095OtherPK