Organization
SPECIALTY MEDICAL
Active
Other names
specialty medical
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG D SULLIVAN (OWNER)
(626) 688-5326
Entity
Organization
Contact information
Practice address
2680 POMONA BLVD STE B, POMONA, CA 91768-3272
(626) 688-5326
(626) 599-2025
Mailing address
2680 POMONA BLVD STE B, POMONA, CA 91768-3272
(626) 688-5326
(800) 619-6826
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
25251
CA
3336C0003X
Community/Retail Pharmacy
PHY42098
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA420980
—
CA
Enumeration date
11/16/2007
Last updated
11/25/2015
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