Provider Demographics
NPI:1619381449
Name:75TH MEDICAL GROUP SGSB
Entity Type:Organization
Organization Name:75TH MEDICAL GROUP SGSB
Other - Org Name:DOD HILL PHARMACY
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 1:75TH MEDICAL GROUP SGSB
Mailing Address - Street 2:7321 11TH ST BLDG 570
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5012
Mailing Address - Country:US
Mailing Address - Phone:801-586-9530
Mailing Address - Fax:801-586-9890
Practice Address - Street 1:5845 E AVE BLDG 412
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5303
Practice Address - Country:US
Practice Address - Phone:801-586-9530
Practice Address - Fax:801-586-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146308OtherPK