Organization
412TH MEDGRP-EDWARDS
Active
Parent organization
412TH MEDGRP-EDWARDS
Other names
DOD EDWARDS PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
412TH MEDGRP-EDWARDS
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
30 NIGHTINGALE RD, BLDG 5525, EDWARDS AFB, CA 93524-1730
(661) 277-2052
(661) 277-8284
Mailing address
95 TH MEDICAL GROUP SGSR, 30 NIGHTINGALE RD. BLDG 5525, EDWARDS AFB, CA 93524-0001
(661) 277-2052
(661) 277-8284
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146265
PK
—
Enumeration date
06/11/2014
Last updated
06/12/2025
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