Healthcare Provider Details

I. General information

NPI: 1649627605
Provider Name (Legal Business Name): DEPARTMENT OF DEFENSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR BLANCHFIELD ARMY COMMUNITY HOSPITAL (IP-PHARMACY)
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

1925 ASHLAND CITY RD APT 408
CLARKSVILLE TN
37043-5298
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8069
  • Fax:
Mailing address:
  • Phone: 513-307-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number0313389
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN KENNETH SANDERS
Title or Position: STAFF PHARMACIST
Credential: RPH
Phone: 270-798-8069