Provider Demographics
NPI:1972600724
Name:WALTER REED NATIONAL MILITARY MED CENTER
Entity Type:Organization
Organization Name:WALTER REED NATIONAL MILITARY MED CENTER
Other - Org Name:MECHANICSBURG BMC PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
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 1:5450 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2411
Mailing Address - Country:US
Mailing Address - Phone:717-605-3409
Mailing Address - Fax:717-605-4817
Practice Address - Street 1:5450 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2411
Practice Address - Country:US
Practice Address - Phone:717-605-3409
Practice Address - Fax:717-605-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085583OtherPK