Provider Demographics
NPI:1609339340
Name:MCDONALD ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:MCDONALD ARMY HEALTH CENTER
Other - Org Name:DOD FT EUSTIS CPBCC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MTF SUPPORT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6096
Mailing Address - Street 1:576 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1373
Mailing Address - Country:US
Mailing Address - Phone:757-914-6000
Mailing Address - Fax:
Practice Address - Street 1:5309 DISCOVERY PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2789
Practice Address - Country:US
Practice Address - Phone:757-914-6355
Practice Address - Fax:757-914-6350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDONALD ARMY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy