Healthcare Provider Details

I. General information

NPI: 1962801928
Provider Name (Legal Business Name): 325TH MEDGRP-TYNDALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAGNOLIA CIR
TYNDALL AFB FL
32403-5604
US

IV. Provider business mailing address

325TH MEDICAL GROUP 340 MAGNOLIA CIRCLE
TYNDALL AFB FL
32403
US

V. Phone/Fax

Practice location:
  • Phone: 850-283-7557
  • Fax: 850-283-7013
Mailing address:
  • Phone: 850-283-7557
  • Fax: 850-283-7013

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: CHIEF DHA PASS
Credential:
Phone: 210-536-6650