Organization
92 MEDICAL GROUP/SGSL
Active
Parent organization
92 MEDICAL GROUP/SGSL
Other names
FAIRCHILD ALT PHCY
Organization subpart
Yes
Provider details
NPI number
Legal business name
92 MEDICAL GROUP/SGSL
Authorized official
HECTOR MORALES (DEPUTY DIRECTOR OF PHARMAC Y OPS)
(210) 221-8443
Entity
Organization
Contact information
Practice address
6955 22ND AVE NE, # 3401, MOSES LAKE, WA 98837-3288
(509) 247-1943
Mailing address
701 HOSPITAL LOOP, # 135, FAIRCHILD AFB, WA 99011-8704
(210) 221-8443
(210) 295-2567
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Enumeration date
03/25/2011
Last updated
03/25/2011
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