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Organization
42ND MEDICAL GROUP SGSL
Active
Organization
42ND MEDICAL GROUP SGSL
Active
Other names
MAXWELL MAIN PHCY42ND MDG
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
330 S TWINING ST BLDG 760, MAXWELL AFB, AL 36112
(334) 953-6868
Mailing address
330 S TWINING ST BLDG 760, MAXWELL AFB, AL 36112
(334) 953-6868
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1993811
PK
—
Enumeration date
09/22/2006
Last updated
10/05/2016
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