Healthcare Provider Details

I. General information

NPI: 1710391156
Provider Name (Legal Business Name): AHC R W BLISS-HUACHUCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 WINROW RD BLDG 45001 RAYMOND W. BLISS ARMY HEALTH CENTER
FORT HUACHUCA AZ
85613-5080
US

IV. Provider business mailing address

RAYMOND W. BLISS ARMY HEALTH CENTER CO MCXJ-RMD-MSAD 2240 E WINROW AVE
FT HUACHUCA AZ
85613-5080
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-2520
  • Fax: 520-533-0464
Mailing address:
  • Phone: 520-533-2520
  • Fax: 520-533-0464

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