Organization
47TH MEDICAL GROUP SGSL
Active
Other names
LAUGHLIN PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
590 MITCHELL BLVD, BLDG 375, LAUGHLIN AFB, TX 78843-5242
(830) 298-6451
(830) 298-6511
Mailing address
590 MITCHELL BLVD, BLDG 375, LAUGHLIN AFB, TX 78843-5242
(830) 298-6451
(830) 298-6511
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2092681
PK
—
Enumeration date
09/22/2006
Last updated
03/28/2016
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