NPIMap

Organization Active NPI

Dunham Army Health Clinic

Doing business as Detrick Phcy

  • Military/U.S. Coast Guard Pharmacy
  • Fort Detrick, MD
National Provider Identifier
1679672083
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
DUNHAM ARMY HEALTH CLINIC
Doing business as
Detrick Phcy
Practice address
1452 Porter St
Ft Detrick, MD 21702
Phone
(301) 619-2850
Fax
(301) 619-7676
NPI assigned
Sep 22, 2006
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

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

Addresses

Primary practice location

1452 Porter St
Ft Detrick, MD 21702

Mailing address

1452 Porter St
2480 Llewellyn Ave Ste 5800
Ft Detrick, MD 21702
Phone (301) 619-2850

Other identifiers 1

IdentifierTypeStateIssuer
2037183OtherPK

Other names 1

  • DETRICK PHCY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Carlisle Dunham Call-in Phcy3 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.

Locations

1452 Porter St
Ft Detrick, MD 21702
Phone (301) 619-2850

1452 Porter St
2480 Llewellyn Ave Ste 5800
Ft Detrick, MD 21702

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1679672083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1452 PORTER ST",
            "address_2": "2480 LLEWELLYN AVE STE 5800",
            "city": "FT DETRICK",
            "state": "MD",
            "postal_code": "21702",
            "telephone_number": "301-619-2850",
            "fax_number": "301-619-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1452 PORTER ST",
            "city": "FT DETRICK",
            "state": "MD",
            "postal_code": "21702",
            "telephone_number": "301-619-2850",
            "fax_number": "301-619-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUNHAM ARMY HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2015-06-03",
        "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": "2037183",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DETRICK PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Detrick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.