Provider Demographics
NPI:1043319213
Name:AHC MONCRIEF-JACKSON
Entity type:Organization
Organization Name:AHC MONCRIEF-JACKSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:BLDG 4575
Mailing Address - Street 2:MARION AVE
Mailing Address - City:FT JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29207
Mailing Address - Country:US
Mailing Address - Phone:803-751-7358
Mailing Address - Fax:803-751-2451
Practice Address - Street 1:BLDG 4575
Practice Address - Street 2:MARION AVE
Practice Address - City:FT JACKSON
Practice Address - State:SC
Practice Address - Zip Code:29207
Practice Address - Country:US
Practice Address - Phone:803-751-7358
Practice Address - Fax:803-751-2451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHC MONCRIEF-JACKSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2091733OtherPK