Healthcare Provider Details

I. General information

NPI: 1063519817
Provider Name (Legal Business Name): WALTER REED NATIONAL MILITARY MED CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GIBNER RD
CARLISLE BARRACKS PA
17013-5090
US

IV. Provider business mailing address

MCXR-CBK-TPC 450 GIBNER RD STE 1 2480 LLEWELLYN AVE STE 5800
CARLISLE BARRACKS PA
17013
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-4509
  • Fax: 717-245-3815
Mailing address:
  • Phone: 210-221-8274
  • Fax: 210-295-2567

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