Healthcare Provider Details

I. General information

NPI: 1215006333
Provider Name (Legal Business Name): 52D MEDGRP-SPANGDAHLEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420TH AB SQ SGSL GERMANY BLDG 208
APO AE
09104
US

IV. Provider business mailing address

420TH AB SQ SGSL GERMANY BLDG 208
APO AE
09104
US

V. Phone/Fax

Practice location:
  • Phone: 210-536-6650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: DHA POD
Credential:
Phone: 210-536-6118