Healthcare Provider Details

I. General information

NPI: 1053724807
Provider Name (Legal Business Name): AHC GUTHRIE-DRUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GUTHRIE AMBULATORY HEALTH CARE CLINIC 11050 MT. BELVEDE
FORT DRUM NY
13602-5004
US

IV. Provider business mailing address

GAHCC-TPCP 11050 MT. BELVEDERE BOULEVARD
FORT DRUM NY
13602-5004
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-3696
  • Fax: 315-772-1691
Mailing address:
  • Phone: 315-772-3696
  • Fax: 315-772-1691

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