Healthcare Provider Details

I. General information

NPI: 1538629415
Provider Name (Legal Business Name): 6TH MEDGRP-MACDILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE BLDG 1078
TAMPA FL
33621-5023
US

IV. Provider business mailing address

3250 ZEMKE AVE BLDG 1078
TAMPA FL
33621-5023
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-7910
  • Fax: 813-828-0088
Mailing address:
  • Phone: 813-827-7910
  • Fax: 813-828-0088

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