Provider Demographics
NPI:1184122749
Name:59TH MDW-WHASC-LACKLAND
Entity type:Organization
Organization Name:59TH MDW-WHASC-LACKLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF THE 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 1:25615 NORTH 281
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-292-0121
Mailing Address - Fax:210-292-8000
Practice Address - Street 1:25615 NORTH 281
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-292-7970
Practice Address - Fax:210-292-8000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:59TH MDW-WHASC-LACKLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175752OtherPK