Organization
55TH MEDICAL GROUP SGSL
Active
Other names
OFFUTT SATL PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
BLDG 107 RM 101, OFFUTT, NE 68113
(402) 294-3221
(402) 294-3228
Mailing address
BLDG 107 RM 101, OFFUTT, NE 68113
(402) 294-3221
(402) 294-3228
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
—
2055513
PK
—
Enumeration date
09/22/2006
Last updated
02/08/2016
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