Healthcare Provider Details

I. General information

NPI: 1861806697
Provider Name (Legal Business Name): ALEXANDER T AUGUSTA MED CTR-FT BELVOIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DEFENSE PENTAGON
WASHINGTON DC
20310-0001
US

IV. Provider business mailing address

NATIONAL NAVAL MEDICAL CTR CO CDR PIUS AIYELAWO 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8692
  • Fax: 703-692-0899
Mailing address:
  • Phone: 703-692-8692
  • Fax: 703-692-0899

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: WILLIAM MICHAEL CONDON
Title or Position: DHA UBO
Credential:
Phone: 240-401-3643