Healthcare Provider Details

I. General information

NPI: 1841606936
Provider Name (Legal Business Name): 19TH MEDGRP-LITTLE ROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 09/19/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-4933
US

IV. Provider business mailing address

19TH MDSS SGSR C/O MARTHA BLAND 1090 ARNOLD DR.
LR AFB AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-7446
  • Fax: 501-987-8786
Mailing address:
  • Phone: 501-987-7446
  • Fax: 501-987-7605

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: CHIEF DHA PASS
Credential:
Phone: 210-536-6650