Provider Demographics
NPI:1023172772
Name:27TH MEDICAL GROUP
Entity type:Organization
Organization Name:27TH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS CENTER MGR
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 1:208 W CASABLANCA AVE BLDG 1400
Mailing Address - Street 2:
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:505-784-4028
Mailing Address - Fax:505-784-4222
Practice Address - Street 1:208 W CASABLANCA AVE BLDG 1400
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:505-784-4028
Practice Address - Fax:505-784-4222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:27TH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy