Provider Demographics
NPI:1619076932
Name:NAVAL MEDICAL CENTER CAMP LEJEUNE
Entity Type:Organization
Organization Name:NAVAL MEDICAL CENTER CAMP LEJEUNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA POSC
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:NAVAL HOSPITAL CAMP LEJEUNE
Mailing Address - Street 2:PO BOX 10100 CODE 0820
Mailing Address - City:CAMP LEJUENE
Mailing Address - State:NC
Mailing Address - Zip Code:28547
Mailing Address - Country:US
Mailing Address - Phone:910-450-0322
Mailing Address - Fax:910-450-4188
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:PHCY DEPTNAVAL HOSP G770
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-450-0322
Practice Address - Fax:910-450-4188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL MEDICAL CENTER CAMP LEJEUNE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068479OtherPK