Organization
17TH MEDGRP-GOODFELLOW
Active
Parent organization
17TH MEDGRP-GOODFELLOW
Other names
DoD GOODFELLOW ePhcy
Organization subpart
Yes
Provider details
NPI number
Legal business name
17TH MEDGRP-GOODFELLOW
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
271 FORT RICHARDSON AVE, GOODFELLOW AFB, TX 76908-4901
(325) 654-3101
(325) 654-5898
Mailing address
17 MEDICAL GROUP, 271 FORT RICHARDSON AVE., GOODFELLOW AFB, TX 76908
(325) 654-3101
(325) 654-5898
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146403
PK
—
Enumeration date
06/19/2014
Last updated
06/13/2025
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