Organization
71ST MEDGRP-VANCE
Active
Parent organization
71ST MEDGRP-VANCE
Other names
DoD VANCE ePhcy
Organization subpart
Yes
Provider details
NPI number
Legal business name
71ST MEDGRP-VANCE
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
527 GOTT RD, ENID, OK 73705-5103
(580) 213-7455
(580) 213-2169
Mailing address
71 MDG MDSS SGSR C/O 71 MDG MDSS SGSR, 527 GOTT RD, ENID, OK 73705
(580) 213-7455
(580) 213-2169
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146676
PK
—
Enumeration date
07/07/2014
Last updated
05/29/2025
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