MEDICARE: WRAMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004804	OTHER		PK

General Provider Information

NPI Number	:	1467551184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRAMC

Provider Business Mailing Address
First Line	:	9300 DEWITT LOOP
Second Line	:	C/O FBCH OTPT TPCP
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-5285
Country	:	US
Telephone Number	:	703-692-8692
Fax Number	:	703-697-4572

Provider Business Practice Location Address
First Line	:	1501 DEFENSE PENTAGON
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20310-0001
Country	:	US
Telephone Number	:	703-692-8692
Fax Number	:	703-697-4572

Authorized Official
Title or Position	:	CHIEF DHA PASS
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-536-6650

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	01/28/2016

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Directions to “WRAMC ” Practice Location

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