Healthcare Provider Details

I. General information

NPI: 1467551093
Provider Name (Legal Business Name): 2D MEDGRP-BARKSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 4709
BARKSDALE AFB LA
71110
US

IV. Provider business mailing address

2MDSS SGSB 243 CURTISS RD STE 100
BARKSDALE AFB LA
71110-2425
US

V. Phone/Fax

Practice location:
  • Phone: 318-456-8348
  • Fax: 318-456-7244
Mailing address:
  • Phone: 318-456-8483
  • Fax: 318-456-7244

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