Provider Demographics
NPI:1558549121
Name:UNITED STATES ARMY AEROMEDICAL CENTER
Entity Type:Organization
Organization Name:UNITED STATES ARMY AEROMEDICAL CENTER
Other - Org Name:RUCKER DENTAL PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER DOD PHARMACY OPS CENTER
Authorized Official - Prefix:MR
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 1:301 ANDREWS RD
Mailing Address - Street 2:ATTN MCXY-RM-TPCP
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-255-7244
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE
Practice Address - Street 2:BLDG 4405
Practice Address - City:FT. RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED STATES ARMY AEROMEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0129709OtherNCPDP