Provider Demographics
NPI:1720744550
Name:USCG ATLANTIC CITY PHARMACY
Entity Type:Organization
Organization Name:USCG ATLANTIC CITY PHARMACY
Other - Org Name:USCG ATLANTIC CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:MR
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 350
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08405-0001
Mailing Address - Country:US
Mailing Address - Phone:609-677-2007
Mailing Address - Fax:609-617-2143
Practice Address - Street 1:BLDG 350
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08405-0001
Practice Address - Country:US
Practice Address - Phone:609-677-2007
Practice Address - Fax:609-617-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient