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General NPI Number Information
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NPI Number | 1487053435
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Entity Type | Organization
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Legal Business Name | 42D MEDGRP-MAXWELL
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 300 TWINING ST
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City | MAXWELL AFB
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State | AL
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Zip | 36112-6027
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Country | US
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Telephone | 334-953-9333
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Fax | 334-953-5272
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Provider Business Mailing Address
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Address Line | USAF-MAXWELL HOSPITAL/SGL 300 SOUTH TWINING ST. BLDG. 760
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City | MAXWELL AFB
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State | AL
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Zip | 36112-0000
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Country | US
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Telephone | 334-953-9333
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Fax | 334-953-5272
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Authorized Official
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Title or Position | DHA POD
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Name | HECTOR MORALES
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Credential |
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Telephone | 210-536-6118
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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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