Healthcare Provider Details

I. General information

NPI: 1669534806
Provider Name (Legal Business Name): FT MACARTHUR PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 MERCURY AVE
EL SEGUNDO CA
90245
US

IV. Provider business mailing address

2305 MERCURY AVE
EL SEGUNDO CA
90245
US

V. Phone/Fax

Practice location:
  • Phone: 310-363-3501
  • Fax:
Mailing address:
  • Phone: 310-363-3501
  • 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: MANAGER PHARMACY OPERATIONS CENTER
Credential:
Phone: 210-221-8443