Organization
KELLY OP PHCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (MGR PHRMCY OPERATIONS CNTR)
(210) 221-8443
Entity
Organization
Contact information
Practice address
204 WAGNER DR, BLDG 1740, KELLY AFB, TX 78241-5846
(210) 925-8304
(210) 292-1962
Mailing address
204 WAGNER DR, BLDG 1740, KELLY AFB, TX 78241-5846
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4511944
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/22/2006
Last updated
03/26/2009
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