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General NPI Number Information
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NPI Number | 1962818336
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Entity Type | Organization
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Legal Business Name | 71ST MEDGRP-VANCE
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 527 GOTT RD
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City | ENID
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State | OK
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Zip | 73705-5103
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Country | US
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Telephone | 580-213-7455
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Fax | 580-213-2169
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Provider Business Mailing Address
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Address Line | 71 MDG MDSS SGSR C/O 71 MDG MDSS SGSR 527 GOTT RD
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City | ENID
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State | OK
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Zip | 73705
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Country | US
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Telephone | 580-213-7455
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Fax | 580-213-2169
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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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