Provider Demographics
NPI:1659470078
Name:NAVAL HEALTH CLINIC PATUXENT RIVER
Entity Type:Organization
Organization Name:NAVAL HEALTH CLINIC PATUXENT RIVER
Other - Org Name:DOD PAX RIVER PHARMACY
Other - Org Type:Doing Business As
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 HEALTH CLINIC PATUXENT RIVER ATTN: FINANCE OFFICE
Mailing Address - Street 2:47149 BUSE RD BLDG 1370
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670
Mailing Address - Country:US
Mailing Address - Phone:301-342-1453
Mailing Address - Fax:301-342-9895
Practice Address - Street 1:BLDG 1370
Practice Address - Street 2:
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670
Practice Address - Country:US
Practice Address - Phone:301-342-1453
Practice Address - Fax:301-342-9895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC PATUXENT RIVER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2037186OtherPK