Healthcare Provider Details

I. General information

NPI: 1891095154
Provider Name (Legal Business Name): ACH BLANCHFIELD-FT CAMPBELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CBPCC- GATEWAY PHARMACY MEDICAL OFFICE BULDG ONE 647 DUNLOP LANE , SUITE 301
CLARRKSVILLE TN
37040-0000
US

IV. Provider business mailing address

BLANCHFIELD ARMY COMMUNITY HOSPITAL 650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8060
  • Fax:
Mailing address:
  • Phone: 270-798-8060
  • 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: CHIEF DHA PASS
Credential:
Phone: 210-536-6650