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General NPI Number Information
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NPI Number | 1043622681
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Entity Type | Organization
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Legal Business Name | 60TH MEDGRP-TRAVIS
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 461 SKYMASTER CIR RM 149
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1909
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Country | US
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Telephone | 707-423-5345
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Fax | 707-423-5346
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Provider Business Mailing Address
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Address Line | DAVID S GRANT MEDICAL CENTER CO 60TH MDG 101 BODIN CIR
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-7657
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Fax | 707-423-7994
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Authorized Official
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Title or Position | CHIEF DHA PASS
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Name | HECTOR MORALES
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Credential |
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Telephone | 210-536-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332000000X
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Taxonomy Name | Military/U.S. Coast Guard Pharmacy
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License Number |
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License Number State |
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