Provider Demographics
NPI:1710252499
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:NAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:PSC BOX 20117
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0117
Mailing Address - Country:US
Mailing Address - Phone:910-440-0011
Mailing Address - Fax:210-295-2567
Practice Address - Street 1:A STREET
Practice Address - Street 2:BLDG # RR 440
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0117
Practice Address - Country:US
Practice Address - Phone:910-440-0011
Practice Address - Fax:910-440-1095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL MEDICAL CENTER CAMP LEJEUNE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134220OtherPK