Organization
59TH MDW-WHASC-LACKLAND
Active
Parent organization
59TH MDW-WHASC-LACKLAND
Other names
DoD RANDOLPH BX ePhcy
Organization subpart
Yes
Provider details
NPI number
Legal business name
59TH MDW-WHASC-LACKLAND
Authorized official
HECTOR MORALES (DHA POD)
(210) 536-6118
Entity
Organization
Contact information
Practice address
221 3RD ST W BLDG 1040, RANDOLPH AFB, TX 78150-4800
(210) 652-4189
(210) 652-3516
Mailing address
359 MEDICAL GROUP C/O 359 MDSS RESOURCE MANAGEMENT OFFI, 221 3RD ST. W, RANDOLPH AFB, TX 78150
(210) 652-4189
(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
—
2147027
PK
—
Enumeration date
07/25/2014
Last updated
07/28/2025
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