Organization
45TH MEDICAL GROUP -SGAM
Active
Other names
PATRICK MAIN PHCY 45TH MDG
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
1381 S PATRICK DR, PATRICK AFB, FL 32925-3606
(321) 494-8290
Mailing address
45TH MEDICAL GROUP, 1381 S PATRICK DR, PATRICK AFB, FL 32925-3606
(321) 494-8290
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
RPH46929
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010632
PK
—
Enumeration date
09/21/2006
Last updated
08/12/2015
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