Healthcare Provider Details

I. General information

NPI: 1194894246
Provider Name (Legal Business Name): 35TH MEDGRP-MISAWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35TH MED GROUP BLDG 99
APO AP
96319-5024
US

IV. Provider business mailing address

35TH MED GROUP BLDG 99
APO AP
96319-5024
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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
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