Provider Demographics
NPI:1588763536
Name:ANDERSEN PHCY
Entity type:Organization
Organization Name:ANDERSEN PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR PHRMCY OPERATIONS CNTR
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:BLDG 26000 SANTA ROSA
Mailing Address - Street 2:
Mailing Address - City:ANDERSEN AFB
Mailing Address - State:GU
Mailing Address - Zip Code:96543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 26000 SANTA ROSA
Practice Address - Street 2:
Practice Address - City:ANDERSEN AFB
Practice Address - State:GU
Practice Address - Zip Code:96543
Practice Address - Country:US
Practice Address - Phone:671-366-5271
Practice Address - Fax:671-366-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5411739OtherOTHER ID NUMBER-COMMERCIAL NUMBER