# LIVERMORE MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689612053
- **Authorized official:** MR. STUART E ROTHROCK (OWNER)
- **Authorized official phone:** (209) 475-0979

## Contact information

- **Practice address:** 1108 E STANLEY BLVD, LIVERMORE, CA 94550-4156
- **Practice address phone:** (925) 371-8170
- **Practice address fax:** (925) 371-1356
- **Mailing address:** 4555 N PERSHING AVE, SUITE \#24, STOCKTON, CA 95207-6740
- **Mailing address phone:** (209) 475-0979
- **Mailing address fax:** (409) 472-0505

## Taxonomy

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

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 08/22/2020