Basic Information
| Provider Information | |||||||||
| NPI: | 1013163088 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAGRAM BTIF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 STANLEY RD STE 208 | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102218443 | ||||||||
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| Practice Location | |||||||||
| Address1: | 724TH MP BN/TF BULLDOG | ||||||||
| Address2: | DISNEY DRIVE BLDG 365 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184313115 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2008 | ||||||||
| LastUpdateDate: | 08/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORALES | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | DEPUTY DIRECTOR DOD PHARMACY OPS CT | ||||||||
| AuthorizedOfficialTelephone: | 2102218443 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332000000X | Y | Suppliers | Military/U.S. Coast Guard Pharmacy |
No ID Information.