Healthcare Provider Details

I. General information

NPI: 1376640128
Provider Name (Legal Business Name): NH JACKSONVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 USS JAMES MADISON RD BLDG 1028 NAVSUBASE
KINGS BAY GA
31547-2531
US

IV. Provider business mailing address

881 USS JAMES MADISON RD BLDG 1028 NAVSUBASE
KINGS BAY GA
31547-2531
US

V. Phone/Fax

Practice location:
  • Phone: 912-673-4264
  • Fax: 912-673-3761
Mailing address:
  • Phone: 912-673-4264
  • Fax: 912-673-3761

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 POSC
Credential:
Phone: 210-536-6650