628TH Medgrp-Charleston

Primary specialty

Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X

Legal business name

628TH MEDGRP-CHARLESTON

Doing business as

Dod Charleston AFB Pharmacy

Practice address

204 W Hill Blvd BLDG 364
Charleston AFB, SC 29404-4704

Phone

(843) 963-6805

Fax

(843) 963-6727

NPI assigned

Jun 26, 2014

Last updated

May 30, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

628TH MEDGRP-CHARLESTONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hector Morales

Title

Chief Dha Pass

Phone

(210) 536-6650

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DOD CHARLESTON AFB PHARMACY Doing business as

Tax ID family

628TH Medgrp-Charleston2 organizations share this tax ID, including this one

Part of

628TH Medgrp-Charleston

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 628TH Medgrp-Charleston

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Charleston AFB, SC
  • NPI 1114905775
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1114332368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 MEDICAL GROUP C/O RMO OFFICE",
            "address_2": "204 W. HILL BLVD. BLDG 364",
            "city": "CHARLESTON AFB",
            "state": "SC",
            "postal_code": "294044704",
            "telephone_number": "843-963-6805",
            "fax_number": "843-963-6727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W HILL BLVD BLDG 364",
            "city": "CHARLESTON AFB",
            "state": "SC",
            "postal_code": "294044704",
            "telephone_number": "843-963-6805",
            "fax_number": "843-963-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "628TH MEDGRP-CHARLESTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "628TH MEDGRP-CHARLESTON",
        "enumeration_date": "2014-06-26",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "CHIEF DHA PASS",
        "authorized_official_telephone_number": "210-536-6650"
    },
    "taxonomies": [
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146517",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOD CHARLESTON AFB PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 628TH Medgrp-Charleston
• George James Antolick, IDMT
• Karen Berkeley, PHARMD
• Shannon L Bolen, MSW
• James Edwin Boyd, M.D.

• Military/U.S. Coast Guard Pharmacy in Charleston AFB, SC
• Providers in Charleston AFB, SC by specialty
• Military/U.S. Coast Guard Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.