Organization
71TH MEDICAL GROUP SGSL
Active
Other names
VANCE PHCY 71ST MDG
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
527 GOTT RD, ENID, OK 73705-5103
(580) 213-7783
(580) 213-7995
Mailing address
527 GOTT RD, ENID, OK 73705-5103
(580) 213-7783
(580) 213-7995
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2076297
PK
—
Enumeration date
09/22/2006
Last updated
01/22/2016
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