Mt Home Refill Phcy

Primary specialty

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

Legal business name

MT HOME REFILL PHCY

Practice address

90 Hope Dr
Mountain Home Afb, ID 83648

Phone

(208) 828-7480

Fax

(208) 828-3785

NPI assigned

Dec 18, 2006

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

Pharmacy Operations Center MGR

Phone

(210) 221-8443

Specialties & licenses 1

Addresses

Tax ID family

366TH Medical Group SGSL2 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.

• 366TH Medical Group SGSL

  • Military/U.S. Coast Guard Pharmacy
  • Mountain Home Afb, ID
  • NPI 1811094667
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffery O'Keefe Sr., RPH

  • Pharmacist
  • MTN Home Afb, ID
  • NPI 1366436958
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219622400000",
    "number": "1801959473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "83648",
            "telephone_number": "208-828-7480",
            "fax_number": "208-828-3785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "83648",
            "telephone_number": "208-828-7480",
            "fax_number": "208-828-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT HOME REFILL PHCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-08-25",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "PHARMACY OPERATIONS CENTER MGR",
        "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": [],
    "endpoints": [],
    "other_names": []
}

• Andrew James Magyan, DO
• Kadeesh McNaught
• Lucas Meehan, MD
• Randall Jay Moore, M.D., M.P.H., C.P.E
• Aaron Philip Morrison, PSYD
• Bichle Thi Nguyen, D.O.
• Paula Michelle Nordstrom, PH.D.
• McKenzie Leigh Nutter, DDS
• Theodore Olenick, DO
• Roberto Olvera, LCSW

• Military/U.S. Coast Guard Pharmacy in Mountain Home Afb, ID
• Providers in Mountain Home Afb, ID by specialty
• Military/U.S. Coast Guard Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.