Organization
359TH MDG
Active
Other names
RANDOLPH BX PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
630 3RD ST W, BLDG 1068, RANDOLPH AFB, TX 78150-4804
(210) 652-6742
(210) 652-3516
Mailing address
221 3RD ST W, BLDG 1040, RANDOLPH AFB, TX 78150-4800
(210) 221-8274
(210) 295-2567
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124452
PK
—
Enumeration date
03/25/2010
Last updated
10/24/2016
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