Healthcare Provider Details

I. General information

NPI: 1437563871
Provider Name (Legal Business Name): FT MEADE MEDDAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE STE 5800 KIMBROUGH AMBULATORY CARE CENTER
FORT MEADE MD
20755-5129
US

IV. Provider business mailing address

KIMBROUGH ACC MILITARY MTF CO CDR USAMEDDAC MCXR-BD 2480 LUWELLYN AVE STE 5800
FT MEADE MD
20755-5129
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8800
  • Fax: 301-677-8456
Mailing address:
  • Phone: 301-677-8800
  • Fax: 301-677-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650