Provider Demographics
NPI:1144899154
Name:USCG HUMBOLDT BAY PHARMACY
Entity type:Organization
Organization Name:USCG HUMBOLDT BAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:1001 LYCOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-9308
Mailing Address - Country:US
Mailing Address - Phone:707-839-6179
Mailing Address - Fax:707-839-6178
Practice Address - Street 1:1001 LYCOMING AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-9308
Practice Address - Country:US
Practice Address - Phone:707-839-6179
Practice Address - Fax:707-839-6178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USCG HUMBOLDT BAY PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy