Provider Demographics
NPI:1316243744
Name:MADIGAN ARMY MEDICAL CTR
Entity type:Organization
Organization Name:MADIGAN ARMY MEDICAL CTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OF PHARMACY OPS
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:210-221-8274
Mailing Address - Street 1:9040A JACKSON AVE
Mailing Address - Street 2:ATTN: MCHJ-CSA-U
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-6598
Mailing Address - Fax:
Practice Address - Street 1:10507 156TH ST E
Practice Address - Street 2:SUITE 112
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-9361
Practice Address - Country:US
Practice Address - Phone:253-307-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADIGAN ARMY MEDICAL CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-02
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4933924OtherNCPDP
1841390077OtherPARENT BILLING FACILITY NPI
1851605356OtherFACILITY NPI