Provider Demographics
NPI:1417799503
Name:AMC EISENHOWER
Entity type:Organization
Organization Name:AMC EISENHOWER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DHA POD
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:210-536-6118
Mailing Address - Street 1:BULDG 1442 16TH STREET
Mailing Address - Street 2:BLDG 1442
Mailing Address - City:CAMP SHELBY
Mailing Address - State:MS
Mailing Address - Zip Code:39407
Mailing Address - Country:US
Mailing Address - Phone:601-558-4469
Mailing Address - Fax:
Practice Address - Street 1:BULDG 1442 16TH STREET
Practice Address - Street 2:BLDG 1442
Practice Address - City:CAMP SHELBY
Practice Address - State:MS
Practice Address - Zip Code:39407
Practice Address - Country:US
Practice Address - Phone:601-558-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC EISENHOWER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy