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628 Medical Group
Military/U.S. Coast Guard Pharmacy in Charleston Afb, South Carolina
NPI 1114905775

628 Medical Group is a Military/U.S. Coast Guard Pharmacy based in Charleston Afb, SC. 628 Medical Group practices in Charleston Afb, SC. The NPI Number for 628 Medical Group is 1114905775 and holds a License No. (South Carolina).

The current practice location address for 628 Medical Group is 204 W Hill Blvd, Charleston Afb, SC and can be reached out via phone at 843-963-6884 and via fax at 843-963-6538.

Location: 204 W Hill Blvd, Charleston Afb, SC, 29404-4704
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1114905775
Provider Name
628 Medical Group
Credential
Provider Entity Type
Organization
Address
204 W Hill Blvd, Charleston Afb, SC, 29404-4704
Phone Number
843-963-6884
Fax Number
843-963-6538
Provider Enumeration Date
01/04/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
42-22181 01 SC NCPDP
institution
Provider Business Practice Location Address Details
Address
204 W Hill Blvd
City
Charleston Afb
State
South Carolina
Zip
29404-4704
Phone Number
843-963-6884
Fax Number
843-963-6538
person
Provider Business Mailing Address Details
Address
204 W Hill Blvd
City
Charleston Afb
State
South Carolina
Zip
29404-4704
Phone Number
843-963-6884
Fax Number
843-963-6538
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Military/U.S. Coast Guard Outpatient
Taxonomy
261QM1100X
License No.
()
Definition
The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Military and U.S. Coast Guard Ambulatory Procedure
Taxonomy
261QM1101X
License No.
()
Definition
That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals.
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Military/U.S. Coast Guard Pharmacy
Speciality
-
Taxonomy
332000000X
License No.
()
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.
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