Provider Demographics
NPI:1922105774
Name:NAVAL HEALTH CLINIC QUANTICO
Entity Type:Organization
Organization Name:NAVAL HEALTH CLINIC QUANTICO
Other - Org Name:WASHINGTON NAVY YARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA POSC
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:210-536-6650
Mailing Address - Street 1:901 M ST SE BLDG 183
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20374-0001
Mailing Address - Country:US
Mailing Address - Phone:202-433-6808
Mailing Address - Fax:202-433-2205
Practice Address - Street 1:901 M ST SE BLDG 183
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-0001
Practice Address - Country:US
Practice Address - Phone:202-433-6808
Practice Address - Fax:202-433-2205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC QUANTICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005910OtherPK