NPIMap

Organization Active NPI

Ft Meade Meddac

Doing business as Raven Rock Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Fairfield, PA
National Provider Identifier
1639938368
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
FT MEADE MEDDAC
Doing business as
Raven Rock Pharmacy
Practice address
Raven Rock Mountain Complex
450 Harbaugh Valley Road
Fairfield, PA 17214
Phone
(717) 878-5252
Fax
(301) 677-8456
NPI assigned
Mar 15, 2024
Last updated
May 30, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
FT MEADE MEDDACAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 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

Raven Rock Mountain Complex
450 Harbaugh Valley Road
Fairfield, PA 17214

Mailing address

Raven Rock Mountain Medical Clinic 2A32
1155 Defense Pentagon
Washington, DC, DC 20301-1155
Phone (717) 878-5252

Other names 1

  • RAVEN ROCK PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ft Meade Meddac25 organizations share this tax ID, including this one
Part of
Ft Meade Meddac

Other organizations with this tax ID 24

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

View all 24

Locations

1155 Defense Pentagon
Washington, DC 20301

NPI Registry JSON

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

{
    "created_epoch": "1710460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1639938368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RAVEN ROCK MOUNTAIN MEDICAL CLINIC 2A32",
            "address_2": "1155 DEFENSE PENTAGON",
            "city": "WASHINGTON, DC",
            "state": "DC",
            "postal_code": "203011155",
            "telephone_number": "717-878-5252",
            "fax_number": "301-677-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RAVEN ROCK MOUNTAIN COMPLEX",
            "address_2": "450 HARBAUGH VALLEY ROAD",
            "city": "FAIRFIELD",
            "state": "PA",
            "postal_code": "17214",
            "telephone_number": "717-878-5252",
            "fax_number": "301-677-8456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT MEADE MEDDAC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FT MEADE MEDDAC",
        "enumeration_date": "2024-03-15",
        "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": "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RAVEN ROCK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RAVEN ROCK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, PA

Sources for this page

  • 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.