Provider Demographics
NPI:1649682162
Name:NAVAL HEALTH CLINIC ANNAPOLIS
Entity type:Organization
Organization Name:NAVAL HEALTH CLINIC ANNAPOLIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA POSC
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:NAVAL HEALTH CLINIC ANNAPOLIS
Mailing Address - Street 2:CO COMPTROLLER UNIFORM OFF 250 WOOD ROAD
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402
Mailing Address - Country:US
Mailing Address - Phone:410-293-1156
Mailing Address - Fax:410-293-2820
Practice Address - Street 1:695 KINKAID RD
Practice Address - Street 2:NAVAL HEALTH CLINIC ANNAPOLIS
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402
Practice Address - Country:US
Practice Address - Phone:410-293-1156
Practice Address - Fax:410-293-2820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC ANNAPOLIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145956OtherPK