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General NPI Number Information
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NPI Number | 1699269852
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Entity Type | Organization
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Legal Business Name | 59TH MDW-WHASC-LACKLAND
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 1940 CARSWELL AVE BLDG 7002
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City | LACKLAND
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State | TX
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Zip | 78236
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Country | US
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Telephone | 210-671-9637
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Fax | 210-671-6486
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Provider Business Mailing Address
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Address Line | 1940 CARSWELL AVE BLDG 7002
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City | LACKLAND
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State | TX
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Zip | 78236
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Country | US
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Telephone | 210-671-9637
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Fax | 210-671-6486
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Authorized Official
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Title or Position | MTF SUPPORT
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Name | CYNTHIA DE LA CRUZ
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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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