Healthcare Provider Details

I. General information

NPI: 1215006499
Provider Name (Legal Business Name): ST MAWGAN PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 804 BOX 6
CORNWALL ENGLAND
AE
GB

IV. Provider business mailing address

PSC 804 BOX 6
CORNWALL ENGLAND
AE
GB

V. Phone/Fax

Practice location:
  • Phone: 011441637876111
  • Fax:
Mailing address:
  • Phone: 011441637876111
  • 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