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Organization
366TH MEDICAL GROUP SGSL
Active
Organization
366TH MEDICAL GROUP SGSL
Active
Other names
MT HOME OP PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
90 HOPE DR, BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7480
(208) 828-3785
Mailing address
90 HOPE DR, BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7480
(208) 828-3785
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
NULL
333600000X
Pharmacy
—
NULL
Other
Enumeration date
09/20/2006
Last updated
02/08/2016
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