Provider Demographics
NPI:1710287198
Name:LAKEHURST
Entity Type:Organization
Organization Name:LAKEHURST
Other - Org Name:LAKEHURST BMC PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR OF PHCY OPS CTR
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 1:39 LANSDOWN ROAD BLDG 39
Mailing Address - Street 2:NAVAL AIR ENGINEERING STATION
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733
Mailing Address - Country:US
Mailing Address - Phone:732-323-2658
Mailing Address - Fax:732-323-2247
Practice Address - Street 1:39 LANSDOWN ROAD BLDG 39
Practice Address - Street 2:NAVAL AIR ENGINEERING STATION
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733
Practice Address - Country:US
Practice Address - Phone:732-323-2658
Practice Address - Fax:732-323-2247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEHURST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy