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General NPI Number Information
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NPI Number | 1598177370
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Entity Type | Organization
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Legal Business Name | 97TH MEDGRP-ALTUS
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 301 N 1ST ST BLDG 46
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City | ALTUS AFB
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State | OK
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Zip | 73523-5004
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Country | US
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Telephone | 580-481-5258
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Fax | 580-481-7420
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Provider Business Mailing Address
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Address Line | 97 MDG MSC FUND C/O MSC TREASURER TSG MARIA DELEON 301 N FIRST ST. BLDG 46
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City | ALTUS AFB
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State | OK
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Zip | 73523
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Country | US
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Telephone | 580-481-5258
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Fax |
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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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