Organization
359TH MDG
Active
Other names
RANDOLPH PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
221 3RD ST W BLDG 1040, UNIVERSAL CITY, TX 78150-4800
(210) 652-4127
(210) 652-3516
Mailing address
221 3RD ST W BLDG 1040, UNIVERSAL CITY, TX 78150-4800
(210) 652-4127
(210) 652-3516
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093375
PK
—
Enumeration date
09/20/2006
Last updated
01/13/2016
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