Basic Information
Provider Information | |||||||||
NPI: | 1255400305 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ERMC UNIFORM BUSINESS OFFICE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HANAU PHCY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2450 STANLEY RD STE 208 | ||||||||
Address2: |   | ||||||||
City: | FORT SAM HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 782346108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102218274 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | USAHC HANAU GERMANY | ||||||||
Address2: |   | ||||||||
City: | HANAU | ||||||||
State: | GERMANY | ||||||||
PostalCode: | AE | ||||||||
CountryCode: | DE | ||||||||
TelephoneNumber: | 2102218274 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/06/2006 | ||||||||
LastUpdateDate: | 02/21/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MORALES | ||||||||
AuthorizedOfficialFirstName: | HECTOR | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER PHARMACY OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 2102218274 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ERMC UNIFORM BUSINESS OFFICE | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332000000X |   |   | Y |   | Suppliers | Military/U.S. Coast Guard Pharmacy |   |
ID Information
ID | Type | State | Issuer | Description | 8110417 | 01 |   | NCPDP | OTHER |