Provider Demographics
NPI:1982010351
Name:AHC LYSTER-FT NOVOSEL
Entity type:Organization
Organization Name:AHC LYSTER-FT NOVOSEL
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:UNITED STATES ARMY AREOMEDICAL CENTER
Mailing Address - Street 2:301 ANDREWS AVENUE C/O ATTN MCXY-RM-TPCP
Mailing Address - City:FT NOVOSEL
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-225-7181
Mailing Address - Fax:334-225-7176
Practice Address - Street 1:301 ANDREWS AVENUE
Practice Address - Street 2:
Practice Address - City:FORT NOVOSEL
Practice Address - State:AL
Practice Address - Zip Code:36362-5350
Practice Address - Country:US
Practice Address - Phone:334-225-7181
Practice Address - Fax:334-225-7176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHC LYSTER-FT NOVOSEL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-07
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146669OtherPK