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General NPI Number Information
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NPI Number | 1316353782
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Entity Type | Organization
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Legal Business Name | FT MEADE MEDDAC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 401 CARPENTER RD BLDG 525
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City | FORT MYER
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State | VA
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Zip | 22211-1009
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Country | US
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Telephone | 703-696-3616
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Fax | 703-696-0276
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Provider Business Mailing Address
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Address Line | KIMBROUGH ACC MILITARY MTF C/O CDR USAMEDDAC MCXR-BD2480 LUWELLYN AVE STE 5800
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City | FT MEADE
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State | MD
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Zip | 20755
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Country | US
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Telephone | 703-696-3616
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Fax | 703-696-0276
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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