| Organization Name: | MALCOLM GROW MEDICAL CLINIC 779 MDG |
| NPI Number: | 1518379395 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HECTOR MORALES (CHIEF DHA PASS) |
| Mailing Address: | 1050 West Perimeter Rd. Joint Base Andrews |
| State: | MD US |
| Postal Code: | 20715 |
| Phone Number: | 2408574566 |
| Fax Number: | 2408574544 |
| NPI Enumeration Date: | 05/28/2014 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Military/U.S. Coast Guard Pharmacy |
| Taxonomy Specialization: | |
| 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. |