Organization
TRAVERSE CITY USCG PHCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (MGR PHRMCY OPERATIONS CNTR)
(210) 221-8443
Entity
Organization
Contact information
Practice address
1175 AIRPORT ACCESS RD, TRAVERSE CITY, MI 49686-3513
(231) 922-8290
(231) 922-8292
Mailing address
1175 AIRPORT ACCESS RD, TRAVERSE CITY, MI 49686-3513
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2364432
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
04/16/2009
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