Provider Demographics
NPI:1912310772
Name:AMC WOMACK-FT BRAGG
Entity type:Organization
Organization Name:AMC WOMACK-FT BRAGG
Other - Org Name:<UNAVAIL>
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 1:2817 ROCK MERRITT AVE STOP A ATTN: MCXC-CA-UBO
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-5000
Mailing Address - Country:US
Mailing Address - Phone:910-907-7497
Mailing Address - Fax:910-570-3371
Practice Address - Street 1:2817 ROCK MERRITT AVE STOP A ATTN: MCXC-CA-UBO
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-5000
Practice Address - Country:US
Practice Address - Phone:910-907-7497
Practice Address - Fax:910-570-3371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC WOMACK-FT BRAGG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145980OtherPK