Healthcare Provider Details

I. General information

NPI: 1548672173
Provider Name (Legal Business Name): AMC EISENHOWER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RODRIGUEZ ARMY HEALTH CLINIC (RAHC) BLDG 21 CHRISMAN RD.
FORT BUCHANAN PR
00934-3400
US

IV. Provider business mailing address

EISENHOWER ARMY MEDICAL CENTER C/O ATTN MCHF-PAD 300 W HOSPITAL ROAD
FT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-2319
  • Fax: 787-707-2591
Mailing address:
  • Phone: 787-707-2319
  • Fax: 787-707-2591

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