Provider Demographics
NPI:1205242310
Name:FT MEADE MEDDAC
Entity type:Organization
Organization Name:FT MEADE MEDDAC
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:KIMBROUGH ACC MILITARY MTF
Mailing Address - Street 2:C/O CDR USAMEDDAC MCXR-BD 2480 LUWELLYN AVE STE 5800
Mailing Address - City:FT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5129
Mailing Address - Country:US
Mailing Address - Phone:301-619-6710
Mailing Address - Fax:301-619-6286
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9254
Practice Address - Country:US
Practice Address - Phone:301-619-6710
Practice Address - Fax:301-619-6286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FT MEADE MEDDAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-09
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
2146748OtherPK