Provider Demographics
NPI:1265756316
Name:86TH MDSS SGSAP
Entity type:Organization
Organization Name:86TH MDSS SGSAP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR PHARMACY OPS CTR
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:210-295-2567
Practice Address - Street 1:BLDG 2114 86TH MDSS SGSAP UNIT 3215
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094-3214
Practice Address - Country:US
Practice Address - Phone:314-479-2541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:86TH MDSS SGSAP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy