Provider Demographics
NPI:1902022601
Name:DETROIT USCG PHCY
Entity Type:Organization
Organization Name:DETROIT USCG PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER DOD PHARMACY OPERATIONS CTR
Authorized Official - Prefix:MR
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 1:2450 STANLEY RD STE 208
Mailing Address - Street 2:ATTN HECTOR MORALES
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6102
Mailing Address - Country:US
Mailing Address - Phone:210-221-8443
Mailing Address - Fax:
Practice Address - Street 1:43355 NORTH JEFFERSON
Practice Address - Street 2:USCG CLINIC - BLDG 825
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48045
Practice Address - Country:US
Practice Address - Phone:586-307-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy