Organization
SHERIAN L PRINCE
Active
Other names
DBA PACIFIC MEDICAL SUPPLY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERIAN L PRINCE (OWNER)
(707) 769-9606
Entity
Organization
Contact information
Practice address
620 PETALUMA BLVD N STE A, PETALUMA, CA 94952-2870
(707) 769-9606
(707) 776-4659
Mailing address
620 PETALUMA BLVD N STE A, PETALUMA, CA 94952-2870
(707) 769-9606
(707) 776-4659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
100669
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME03174F
—
CA
Enumeration date
11/15/2006
Last updated
08/22/2020
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