Provider Demographics
NPI:1518036797
Name:SHAPE HEALTH FACILITY
Entity Type:Organization
Organization Name:SHAPE HEALTH FACILITY
Other - Org Name:SHAPE PHCY
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:SHAPE HEALTH FACILITY
Mailing Address - Street 2:UNIT 21414 BOX 3530
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SHAPE HEALTH FACILITY
Practice Address - Street 2:UNIT 21414
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705
Practice Address - Country:US
Practice Address - Phone:210-221-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113965OtherPK
1093889552OtherPARENT FACILITY LANDSTUHL REGIONAL MEDCEN NPI
8110607OtherNCPDP