Healthcare Provider Details

I. General information

NPI: 1245337096
Provider Name (Legal Business Name): 72D MEDGRP-TINKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK
73145-8716
US

IV. Provider business mailing address

7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK
73145-8716
US

V. Phone/Fax

Practice location:
  • Phone: 57-342-7784
  • Fax:
Mailing address:
  • Phone: 405-734-2778
  • 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: DHA POD SR PROGRAM ANALYST
Credential:
Phone: 210-536-6118