Provider Demographics
NPI:1023115888
Name:MCKINLEYVILLE USCG PHCY
Entity type:Organization
Organization Name:MCKINLEYVILLE USCG PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR PHRMCY OPERATIONS CNTR
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 1:1001 LYCOMING AVE
Mailing Address - Street 2:USCG GROUP HUMBOLDT BAY
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-9308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 LYCOMING AVE
Practice Address - Street 2:USCG GROUP HUMBOLDT BAY
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-9308
Practice Address - Country:US
Practice Address - Phone:707-839-6179
Practice Address - Fax:707-839-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0586199OtherOTHER ID NUMBER-COMMERCIAL NUMBER