NPIMap

Organization Active NPI

AMC Eisenhower

Doing business as Ft Eisenhower Connelly Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Fort Gordon, GA
National Provider Identifier
1215036983
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
AMC EISENHOWER
Doing business as
Ft Eisenhower Connelly Pharmacy
Practice address
Avenue B BLDG 29709
Mark Connelly Health Clinic
Ft Gordon, GA 30905
Phone
(706) 787-5167
Fax
(706) 787-6175
NPI assigned
Sep 21, 2006
Last updated
Jun 11, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
AMC EISENHOWERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Hector Morales
Title
Dha Pod Sr Program Analyst
Phone
(210) 536-6650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Pharmacy 332000000X Primary

Addresses

Primary practice location

Avenue B BLDG 29709
Mark Connelly Health Clinic
Ft Gordon, GA 30905

Mailing address

Eisenhower Army Medical Center
Attn MCHF-Pad
Ft Gordon, GA 30905-5741
Phone (706) 787-5167

Other identifiers 1

IdentifierTypeStateIssuer
2020249OtherPK

Other names 1

  • FT EISENHOWER CONNELLY PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
AMC Eisenhower16 organizations share this tax ID, including this one
Part of
AMC Eisenhower

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1215036983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "EISENHOWER ARMY MEDICAL CENTER",
            "address_2": "ATTN MCHF-PAD",
            "city": "FT GORDON",
            "state": "GA",
            "postal_code": "309055741",
            "telephone_number": "706-787-5167",
            "fax_number": "706-787-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AVENUE B BLDG 29709",
            "address_2": "MARK CONNELLY HEALTH CLINIC",
            "city": "FT GORDON",
            "state": "GA",
            "postal_code": "30905",
            "telephone_number": "706-787-5167",
            "fax_number": "706-787-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMC EISENHOWER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMC EISENHOWER",
        "enumeration_date": "2006-09-21",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "DHA POD SR PROGRAM ANALYST",
        "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": "2020249",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FT EISENHOWER CONNELLY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Gordon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.