Provider Demographics
NPI:1497852255
Name:ERMC
Entity Type:Organization
Organization Name:ERMC
Other - Org Name:TIKRIT PHARMACY
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:210-221-8274
Mailing Address - Street 1:2450 STANLEY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7510
Mailing Address - Country:US
Mailing Address - Phone:210-221-8274
Mailing Address - Fax:
Practice Address - Street 1:2450 STANLEY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7510
Practice Address - Country:US
Practice Address - Phone:210-221-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
8110746OtherOTHER ID NUMBER-COMMERCIAL NUMBER