Healthcare Provider Details

I. General information

NPI: 1427465889
Provider Name (Legal Business Name): 87TH MEDGRP-JB MCGUIRE-DIX-LAKEHURST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

IV. Provider business mailing address

87TH MEDICAL GROUP C/O RESOURCE MANAGEMENT OFFICE 3548 NEELY RD.
JOINT BASE MDL NJ
08641
US

V. Phone/Fax

Practice location:
  • Phone: 609-754-9464
  • Fax: 609-754-9133
Mailing address:
  • Phone: 609-754-9464
  • Fax: 609-754-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
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