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General NPI Number Information
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NPI Number | 1619381415
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Entity Type | Organization
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Legal Business Name | 81ST MEDGRP-KEESLER
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 506 LARCHER BLVD STE B
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City | KEESLER AFB
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State | MS
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Zip | 39534-2342
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Country | US
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Telephone | 228-377-6585
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Fax | 228-376-0058
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Provider Business Mailing Address
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Address Line | DEPARTMENT OF AIR FORCE 81ST MEDICAL GROUP 301 FISHER ST. STE 104
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City | KEESLER AFB
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State | MS
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Zip | 39534-2517
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Country | US
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Telephone | 228-376-0058
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Fax | 228-377-6582
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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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