Organization
96TH MEDICAL SUPPORT SQUADRON
Active
Other names
EGLIN NOMAD MED CAB PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
307 BOATNER RD STE 114, BLDG 1405, EGLIN AFB, FL 32542-1302
(850) 883-8444
(850) 883-8429
Mailing address
96TH MEDICAL SUPPORT SQUADRON, 307 BOATNER RD STE, EGLIN AFB, FL 32542-1302
(850) 883-8444
(850) 883-8429
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013214
PK
—
Enumeration date
09/21/2006
Last updated
06/11/2015
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