Provider Demographics
NPI:1861804643
Name:36TH MEDGRP-MARIANAS GUAM
Entity type:Organization
Organization Name:36TH MEDGRP-MARIANAS GUAM
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:ERMC UNIFORM BUSINESS OFFICE
Mailing Address - Street 2:CMR 402 BLDG 3700 ERMC UBO
Mailing Address - City:AGANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-366-5271
Mailing Address - Fax:671-366-1229
Practice Address - Street 1:36TH MEDICAL SUPPORT SQUADRON
Practice Address - Street 2:26001
Practice Address - City:AGANA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-366-5271
Practice Address - Fax:671-366-1229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:36TH MEDGRP-MARIANAS GUAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145944OtherPK