Provider Demographics
NPI:1366549115
Name:ACH BLANCHFIELD-FT CAMPBELL
Entity type:Organization
Organization Name:ACH BLANCHFIELD-FT CAMPBELL
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 1:5979 DESERT STORM AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5514
Mailing Address - Country:US
Mailing Address - Phone:270-956-0374
Mailing Address - Fax:270-798-8065
Practice Address - Street 1:5979 DESERT STORM AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5514
Practice Address - Country:US
Practice Address - Phone:270-956-0374
Practice Address - Fax:270-798-8065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACH BLANCHFIELD-FT CAMPBELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2033104OtherPK
1825883OtherOTHER ID NUMBER-COMMERCIAL NUMBER