Healthcare Provider Details

I. General information

NPI: 1912061664
Provider Name (Legal Business Name): BG CRAWFORD F SAMS ARMY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011 CAMP ZAMA OTC PHCY
APO AP
96338-5011
US

IV. Provider business mailing address

MSA OFFICE ATTN MCJA-PA
APO AP
96343-5011
US

V. Phone/Fax

Practice location:
  • Phone: 01181464074475
  • Fax:
Mailing address:
  • Phone: 01181464074693
  • 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: PHARMACY OPERATIONS CENTER MGR
Credential:
Phone: 210-221-8443