Healthcare Provider Details

I. General information

NPI: 1487954863
Provider Name (Legal Business Name): NAVAL HOSPITAL GUAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG # 6 CHAPEL RD
SANTA RITA GU
96915
US

IV. Provider business mailing address

PSC 490 BOX 156 FPO AP
SANTA RITA GU
96540
US

V. Phone/Fax

Practice location:
  • Phone: 671-339-3017
  • Fax: 671-339-5002
Mailing address:
  • Phone: 671-339-3017
  • Fax: 671-339-5002

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: DEPUTY DIRECTOR OF PHARMACY OPS
Credential:
Phone: 210-221-8443