354 MDG


Address: 2630 Central Ave Ste 1m07, Eielson Afb, AK 99702-2325
Phone: 9073771462

354 MDG (NPI# 1902218415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1902218415
Entity Type Organization
Organization Name 354 MDG
Other Organization Name DOD EIELSON EPHCY
Practice Address 2630 Central Ave Ste 1m07
Eielson Afb
AK 99702-2325
Mailing Address 354 Mdg
2630 Cental Ave Ste 1m07
Eielson Afb
AK 99702-2325
Practice Telephone 9073771462
Practice Fax Number 9073774105
Mailing Telephone 9073771462
Mailing Fax Number 9073774105
Enumeration Date 2014-06-02
Last Update Date 2015-06-11
Authorized Official Name HECTOR MORALES (CHIEF DHA PASS)
Authorized Official Telephone 2105366650
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 332000000X Military/U.S. Coast Guard Pharmacy Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
PK 2146023 01

Other Provider/Organization Names

Other Name Type Code
DoD EIELSON ePhcy Doing Business As Name - Organization

Office Location

Street Address 2630 CENTRAL AVE STE 1M07
City EIELSON AFB
State AK
Zip Code 99702-2325

Providers in the same location

NPI Name Taxonomy Address Enumeration
1427205335 Adam Charles Willett Pharmacist 2630 Central Ave Ste 1m07, Eielson Afb, AK 99702-2325 2008-08-21
1811597990 Thomas A Mccarthy II Dental Hygienist 2630 Central Ave Ste 1m07, Attention: Dental Flight, Eielson Afb, AK 99702-2397 2020-10-28

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1174864904 Eric Noll Optometrist 2630 Central Ave # 3349, Eielson Afb, AK 99702 2013-03-04
1407125123 Optical Center Technician/Technologist 451 Broadway Street, Eielson Afb Aafes Exchange, Eielson, AK 99702 2011-12-27
1063649234 John Michael Strothenke Military Health Care Provider 2630 Central Avenue Suite 1, 354 Medical Operations Squadron, Clinical Medicine Flt, Eielson Air Force Base, AK 99702 2009-06-16
1225272073 Landru Derek Medvec Military Health Care Provider 2422 Arctic Ave, Apt D, Eielson Afb, AK 99702 2009-04-23
1780875617 Victoria L Ketchum Specialist E. Cowles, Fairbanks Memorial Hospital, Fairbanks, AK 99702 2007-08-06
1689768103 Angie M. Walker Social Worker 2630 Central Av, Suite 1m07, Eielson Afb, AK 99702 2006-10-02
1306945464 354th Medical Group Mdg Military/U.S. Coast Guard Pharmacy Bldg 3349 Central Ave, Eielson Afb, AK 99702 2006-09-22
1760442297 Susan Mary Runyan Dietitian, Registered 354th Medical Group, 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702 2006-03-27
1972166916 Andrew Joseph Colburn Registered Nurse 2630 Central Ave # 3349, Eielson Afb, AK 99702 2019-04-16
1952885121 Anthony Ewell-kollmann Dentist 2630 Central Ave, Eielson Afb, AK 99702 2018-09-24
Find all providers in zip 99702

Taxonomy Information

Taxonomy Code 332000000X
Grouping Suppliers
Classification Military/U.S. Coast Guard Pharmacy

Taxonomy Definition

A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services.
Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306945464 354th Medical Group Mdg Military/U.S. Coast Guard Pharmacy Bldg 3349 Central Ave, Eielson Afb, AK 99702 2006-09-22
1902867229 354th Medical Group Military/U.S. Coast Guard Pharmacy 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702-2325 2006-03-28

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1427217447 Bassett Army Community Hospital Military/U.S. Coast Guard Pharmacy 131dg 661 Artic Ave, Fr Greely, AK 99731 2008-06-05
1104925262 Us Coast Guard Finance Center Military/U.S. Coast Guard Pharmacy Bldg N46 Isc Kodiak, Kodiak, AK 99619 2006-09-22
1013016179 Us Coast Guard Finance Center Military/U.S. Coast Guard Pharmacy 1300 Stedman Stisc Ketchikan, Ketchikan, AK 99901 2006-09-22
1053418806 Bassett Army Community Hospital Military/U.S. Coast Guard Pharmacy 1060 Gaffney Rd Stop 7420, Bldg 4065, Ft Wainwright, AK 99703-5007 2006-09-20
1821402652 673rd Medical Group Joint Base Elmendorf-richardson Military/U.S. Coast Guard Pharmacy 5955 Zeamer Ave, 673rd Medical Group, Jber, AK 99506-3702 2014-06-19
1295149383 Bassett Army Community Hospital Military/U.S. Coast Guard Pharmacy Bassett Army Community Hospital, Meddac-alaska 1060 Gaffney Rd #7400, Ft. Wainwright, AK 99703-7400 2014-06-17
1629481486 673rd Medical Group Joint Base Elmendorf-richardson Jber Military/U.S. Coast Guard Pharmacy 5800 Westover Ave, Jber, AK 99506-1603 2014-06-09
1285948877 Hswl Fo Kodiak Det Ketchikan Military/U.S. Coast Guard Pharmacy 1300 Stedman St, Ketchikan, AK 99901-6661 2010-08-06
1053410100 Bassett Army Community Hospital Military/U.S. Coast Guard Pharmacy 1060 Gaffney Rd Stop 7400, Building 3406, Ft Wainwright, AK 99703-5007 2006-09-22
1497854558 Bassett Army Community Hospital Military/U.S. Coast Guard Pharmacy 1060 Gaffney Rd Stop 7400, Bldg 4065, Ft Wainwright, AK 99703-5007 2006-09-22
Find all providers with the same taxonomy

Competitor

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City EIELSON AFB
Zip Code 99702

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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