Provider Demographics
NPI:1013163088
Name:BAGRAM BTIF
Entity Type:Organization
Organization Name:BAGRAM BTIF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR DOD PHARMACY OPS CT
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 1:2450 STANLEY RD STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6108
Mailing Address - Country:US
Mailing Address - Phone:210-221-8443
Mailing Address - Fax:
Practice Address - Street 1:724TH MP BN/TF BULLDOG
Practice Address - Street 2:DISNEY DRIVE BLDG 365
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09354
Practice Address - Country:US
Practice Address - Phone:318-431-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy