Healthcare Provider Details

I. General information

NPI: 1982703013
Provider Name (Legal Business Name): AHC KENNER-FT GREGG-ADAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 3219
FT LEE VA
23801
US

IV. Provider business mailing address

700 24TH ST ATTN RMO
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-7836
  • Fax: 804-734-9658
Mailing address:
  • Phone: 804-734-9141
  • Fax: 804-734-9658

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