Healthcare Provider Details

I. General information

NPI: 1639231632
Provider Name (Legal Business Name): WRAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DEFENSE PENTAGON
WASHINGTON DC
20310
US

IV. Provider business mailing address

9300 DEWITT LOOP ATTN FBCH OTPT TPCP
FT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 210-221-8274
  • Fax:
Mailing address:
  • Phone: 571-231-2856
  • 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: 210-221-8274