359TH MDG

Primary specialty

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

Legal business name

359TH MDG

Doing business as

RANDOLPH BX PHCY

Practice address

630 3Rd St W
BLDG 1068
Randolph Afb, TX 78150-4804

Phone

(210) 652-6742

Fax

(210) 652-3516

NPI assigned

Mar 25, 2010

Organization subpart

No

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

• RANDOLPH BX PHCY Doing business as

Tax ID family

359TH MDG3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• 12TH Medical Group Randolph

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Randolph a F B, TX
  • NPI 1316911597
  NPD tax ID
• 359TH MDG

  • Military/U.S. Coast Guard Pharmacy
  • Universal City, TX
  • NPI 1598862344
  NPD tax ID

Locations

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477267200000",
    "number": "1306160973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 3RD ST W",
            "address_2": "BLDG 1040",
            "city": "RANDOLPH AFB",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-221-8274",
            "fax_number": "210-295-2567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 3RD ST W",
            "address_2": "BLDG 1068",
            "city": "RANDOLPH AFB",
            "state": "TX",
            "postal_code": "781504804",
            "telephone_number": "210-652-6742",
            "fax_number": "210-652-3516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "359TH MDG",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-25",
        "last_updated": "2016-10-24",
        "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": "2124452",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RANDOLPH BX PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 59TH MDW-Whasc-Lackland
• Gary Lynn Abbott, OD
• Jenara Leigh Allen, DDS
• Precious Arnette, FNP
• Kemal Feroze Baksh, DDS

• Military/U.S. Coast Guard Pharmacy in Randolph Afb, TX
• Providers in Randolph Afb, TX by specialty
• Military/U.S. Coast Guard Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; 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.