MEDICARE: NMC PORTSMOUTH

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	2104773	OTHER		PK

General Provider Information

NPI Number	:	1609966936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NMC PORTSMOUTH

Provider Business Mailing Address
First Line	:	620 JHN PAUL JNS CIR
Second Line	:	ATTN MRS. GOODRICH 3RD PARTY COLLECTION
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708-2111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL WEAPONS STATION YORKTOWN
Second Line	:	BLDG 1806
City	:	YORKTOWN
State	:	VA
Zip	:	23691-0090
Country	:	US
Telephone Number	:	757-953-8402
Fax Number	:	757-953-8446

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/30/2025

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Directions to “NMC PORTSMOUTH ” Practice Location

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