MEDICARE: US COAST GUARD FINANCE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1997601	OTHER		PK

General Provider Information

NPI Number	:	1114024973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US COAST GUARD FINANCE CENTER

Provider Business Mailing Address
First Line	:	599 TOMALES RD BLDG 225
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5002
Country	:	US
Telephone Number	:	707-765-7194
Fax Number	:	707-765-7521

Provider Business Practice Location Address
First Line	:	599 TOMALES RD BLDG 225
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5002
Country	:	US
Telephone Number	:	707-765-7194
Fax Number	:	707-765-7521

Authorized Official
Title or Position	:	CHIEF DHA PASS
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-536-6650

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/13/2015

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Directions to “US COAST GUARD FINANCE CENTER ” Practice Location

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