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General NPI Number Information
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NPI Number | 1417356072
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Entity Type | Organization
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Legal Business Name | 27TH SPECIAL OPS MEDGRP-CANNON
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 224 WEST D. L. INGRAM BLVD BLDG 1408
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City | CANNON AFB
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State | NM
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Zip | 88103-5103
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Country | US
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Telephone | 575-784-4912
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Fax | 575-784-7494
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Provider Business Mailing Address
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Address Line | 27TH MEDICAL GROUP SGSL 208 W. D.L. INGRAM BLVD. 1ST FLOOR
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 575-784-4028
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Fax | 575-784-7494
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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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