Organization
JAMES A LOVELL FHCC
Active
Other names
DoD GREAT LAKES BURKEY MALL ePhcy
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
2630 GREEN BAY RD BLDG 3452, NORTH CHICAGO, IL 60088-3303
(847) 688-2772
(847) 688-2805
Mailing address
PO BOX 322, JAMES A LOVELL FHCC, NORTH CHICAGO, IL 60064
(224) 610-4232
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146521
PK
—
Enumeration date
06/30/2014
Last updated
11/24/2015
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