Provider Demographics
NPI:1760561245
Name:121ST CSH/BAACH
Entity type:Organization
Organization Name:121ST CSH/BAACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DHA POD SR PROGRAM ANALYST
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:UNIT 15244 BOX 316
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:US
Mailing Address - Phone:0118227-917-6090
Mailing Address - Fax:
Practice Address - Street 1:BLDG 7005
Practice Address - Street 2:
Practice Address - City:SEOUL
Practice Address - State:KOREA
Practice Address - Zip Code:AP
Practice Address - Country:KR
Practice Address - Phone:0118227-916-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:121ST CSH/BAACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
8210077OtherNCPDP
1760550636OtherPARENT NPI