Basic Information
Provider Information | |||||||||
NPI: | 1346960846 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | USCG BASE CHARLESTON PHARMACY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | USCG CHARLESTON PHARMACY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 300 E MAIN ST STE 1000 | ||||||||
Address2: |   | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235109109 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437946713 | ||||||||
FaxNumber: | 7275354190 | ||||||||
Practice Location | |||||||||
Address1: | 1050 REGISTER ST | ||||||||
Address2: |   | ||||||||
City: | N CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294052421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137946713 | ||||||||
FaxNumber: | 7275354190 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/02/2022 | ||||||||
LastUpdateDate: | 09/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MORALES | ||||||||
AuthorizedOfficialFirstName: | HECTOR | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF DHA POSC | ||||||||
AuthorizedOfficialTelephone: | 2105366650 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332000000X |   |   | Y |   | Suppliers | Military/U.S. Coast Guard Pharmacy |   |
No ID Information.