Healthcare Provider Details

I. General information

NPI: 1720744550
Provider Name (Legal Business Name): USCG ATLANTIC CITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 350
ATLANTIC CITY NJ
08405-0001
US

IV. Provider business mailing address

BLDG 350
ATLANTIC CITY NJ
08405-0001
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-2007
  • Fax: 609-617-2143
Mailing address:
  • Phone: 609-677-2007
  • Fax: 609-617-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

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