Andersen Phcy

Primary specialty

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

Legal business name

ANDERSEN PHCY

Practice address

BLDG 26000 Santa Rosa
Andersen AFB, GU 96543

Phone

(671) 366-5271

Fax

(671) 366-1229

NPI assigned

Sep 22, 2006

Last updated

Jun 17, 2008By the provider in NPPES

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

MGR Phrmcy Operations CNTR

Phone

(210) 221-8443

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

36TH Medgrp-Marianas Guam2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• 36TH Medgrp-Marianas Guam

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • NPI 1679540900
  NPD tax ID

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1588763536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 26000 SANTA ROSA",
            "city": "ANDERSEN AFB",
            "state": "GU",
            "postal_code": "96543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 26000 SANTA ROSA",
            "city": "ANDERSEN AFB",
            "state": "GU",
            "postal_code": "96543",
            "telephone_number": "671-366-5271",
            "fax_number": "671-366-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSEN PHCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "MGR PHRMCY OPERATIONS CNTR",
        "authorized_official_telephone_number": "210-221-8443"
    },
    "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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5411739",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derrick Bailey
• John Garcia, IDMT
• Benjamin Huyck
• Imee Sarmiento Kiser, IDMT
• Scott Christopher Martin, O.D.

• Military/U.S. Coast Guard Pharmacy in Andersen AFB, GU
• Providers in Andersen AFB, GU by specialty
• Military/U.S. Coast Guard Pharmacy in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.