Healthcare Provider Details

I. General information

NPI: 1528298585
Provider Name (Legal Business Name): 48TH MEDGRP-LAKENHEATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 ABG/SG MEDICAL
RAF CROUGHTON ENGLAND
APO AE
GB

IV. Provider business mailing address

2450 STANLEY RD STE 208
FORT SAM HOUSTON TX
78234-6108
US

V. Phone/Fax

Practice location:
  • Phone: 0114401280708533
  • Fax: 0114401280708719
Mailing address:
  • Phone: 210-221-8443
  • 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: DHA POD
Credential:
Phone: 210-536-6118