Healthcare Provider Details

I. General information

NPI: 1467551754
Provider Name (Legal Business Name): AMC WOMACK-FT BRAGG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MAYNARD ST
POPE AFB NC
28308
US

IV. Provider business mailing address

2817 REILLY ST MCXC-DBO-UBO WAMC STOP A
FORT BRAGG NC
28310-7324
US

V. Phone/Fax

Practice location:
  • Phone: 910-394-2208
  • Fax: 910-394-1266
Mailing address:
  • Phone: 910-907-8537
  • Fax:

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