Provider Demographics
NPI:1043375389
Name:325TH MEDICAL GROUP
Entity type:Organization
Organization Name:325TH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CHIEF, PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-283-7423
Mailing Address - Street 1:340 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403-5604
Mailing Address - Country:US
Mailing Address - Phone:850-283-7423
Mailing Address - Fax:850-283-7013
Practice Address - Street 1:340 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403-5604
Practice Address - Country:US
Practice Address - Phone:850-283-7423
Practice Address - Fax:850-283-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205849261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center