1811096852 NPI number — NAVAL HOSPITAL BREMERTON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811096852 NPI number — NAVAL HOSPITAL BREMERTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAL HOSPITAL BREMERTON
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 BREMERTON 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:
1811096852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
US NAVAL HOSPITAL BREMERTON WA C/O NAVAL HOSPITAL BREME
Provider Second Line Business Mailing Address:
1 BOONE RD CODE 08RAZD
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98312-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-475-4425
Provider Business Mailing Address Fax Number:
360-475-4676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BOONE RD
Provider Second Line Business Practice Location Address:
CODE 072
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-475-4425
Provider Business Practice Location Address Fax Number:
360-475-4786
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF DHA POSC
Authorized Official Telephone Number:
210-536-6650

Provider Taxonomy Codes

  • Taxonomy code: 332000000X , with the licence number:  PH00020811 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2110397 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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