Basic Information
| Provider Information | |||||||||
| NPI: | 1821470774 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARQUIST ARMY HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 PORTER ST | ||||||||
| Address2: | |||||||||
| City: | FORT DETRICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217029254 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1434 PORTER ST | ||||||||
| Address2: | |||||||||
| City: | FORT DETRICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217029254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016197175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2015 | ||||||||
| LastUpdateDate: | 06/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | VONGXAY-SANO | ||||||||
| AuthorizedOfficialFirstName: | PRASATHIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | STAFF PHARMACIST | ||||||||
| AuthorizedOfficialTelephone: | 3016197175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 11850 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.