1184793309 NPI number — 121ST CSH/BAACH

Table of content: AMANDA MORAN LANIER MD (NPI 1669486411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184793309 NPI number — 121ST CSH/BAACH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
121ST CSH/BAACH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOD CAMP WALKER TMC PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184793309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIT 15244 BOX 316
Provider Second Line Business Mailing Address:
ATTN UBO
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96205-5244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
01182279176090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 349
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP WALKER
Provider Business Practice Location Address State Name:
KOREA
Provider Business Practice Location Address Postal Code:
AP
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
01182534705588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
DHA POD SR PROGRAM ANALYST
Authorized Official Telephone Number:
210-221-8443

Provider Taxonomy Codes

  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8210065 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1548475619 . This is a "FACILITY USAHC-CAMP WALKER NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760550636 . This is a "PARENT FACILITY 121ST CSH/BAACH NPI" identifier . This identifiers is of the category "OTHER".




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