| NPI | 1114905775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENA LYNN HANSKEN Air Force Uniform Business Office 703-588-6419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Additional Taxonomies | 332000000X MilitaryU.S. Coast Guard Pharmacy |
| 261QM1101X Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2012-01-27 |