Healthcare Provider Details

I. General information

NPI: 1518066653
Provider Name (Legal Business Name): AMC MADIGAN-FT LEWIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 11582 17TH AND C ST MADIGAN ARMY MEDICAL CTR
NORR FORT LEWIS WA
98433
US

IV. Provider business mailing address

BLDG 11582 17TH AND C ST MADIGAN ARMY MEDICAL CTR
NORR FORT LEWIS WA
98433
US

V. Phone/Fax

Practice location:
  • Phone: 253-966-7623
  • Fax: 253-968-3349
Mailing address:
  • Phone: 253-966-7623
  • Fax: 253-968-3349

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