Basic Information
| Provider Information | |||||||||
| NPI: | 1972919348 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRIPLER ARMY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DOD SCHOFIELD PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | TRIPLER ARMY MEDICAL CENTER | ||||||||
| Address2: | 1 JARRETT WHITE RD PAD MCHK-PAT-T | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084338423 | ||||||||
| FaxNumber: | 8084338417 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 676 | ||||||||
| Address2: | |||||||||
| City: | SCHOFIELD BARRACKS | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968575460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084338423 | ||||||||
| FaxNumber: | 8084338417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2014 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORALES | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF DHA PASS | ||||||||
| AuthorizedOfficialTelephone: | 2105366650 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/06/2021 | ||||||||
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 | 2146675 | 01 | PK | OTHER |