# PACIFIC MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pacific Medical Supply
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376634873
- **Authorized official:** MR. FIDELIS GABRIEL EKONG (OWNER)
- **Authorized official phone:** (951) 552-0322

## Contact information

- **Practice address:** 574 CALHOUN ST, CORONA, CA 92879-5846
- **Practice address phone:** (951) 553-0322
- **Practice address fax:** (951) 279-6004
- **Mailing address:** 574 CALHOUN ST, CORONA, CA 92879-5846
- **Mailing address phone:** (951) 553-0322
- **Mailing address fax:** (951) 279-6004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 08/22/2020