=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528298585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 48TH MEDGRP-LAKENHEATH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2009
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 422 ABG/SG MEDICAL
-----------------------------------------------------
City | RAF CROUGHTON
-----------------------------------------------------
State | ENGLAND
-----------------------------------------------------
Zip | APO AE
-----------------------------------------------------
Country | GB
-----------------------------------------------------
Telephone | 0114401280708533
-----------------------------------------------------
Fax | 0114401280708719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2450 STANLEY RD STE 208
-----------------------------------------------------
City | FORT SAM HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78234-6108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-221-8443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DHA POD
-----------------------------------------------------
Name | HECTOR MORALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-536-6118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332000000X
-----------------------------------------------------
Taxonomy Name | Military/U.S. Coast Guard Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------