Provider Demographics
NPI:1619297991
Name:51 MED GP
Entity Type:Organization
Organization Name:51 MED GP
Other - Org Name:TAEGU IDMT PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR OF PHCY OPS
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:210-221-8443
Mailing Address - Street 1:607 MMS/MSSG
Mailing Address - Street 2:UNIT 96213
Mailing Address - City:TAEGU
Mailing Address - State:TAEGU
Mailing Address - Zip Code:APO AP 96213
Mailing Address - Country:KP
Mailing Address - Phone:210-221-8443
Mailing Address - Fax:210-295-2567
Practice Address - Street 1:607 MMS/MSSG
Practice Address - Street 2:UNIT 2166
Practice Address - City:TAEGU
Practice Address - State:TAEGU
Practice Address - Zip Code:APO AP 96213
Practice Address - Country:KP
Practice Address - Phone:210-221-8443
Practice Address - Fax:210-295-2567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:51 MED GP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy