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General NPI Number Information
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NPI Number | 1508522939
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Entity Type | Organization
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Legal Business Name | USCG TRAVERSE CITY PHARMACY
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1175 AIRPORT RD
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City | TRAVERSE CITY
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State | MI
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Zip | 49686
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Country | US
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Telephone | 231-922-8290
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Fax | 231-922-8292
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Provider Business Mailing Address
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Address Line | 300 E MAIN ST STE 1000
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City | NORFOLK
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State | VA
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Zip | 23510-9109
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Country | US
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Telephone | 231-922-8290
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Fax | 231-922-8292
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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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