Organization
PACIFIC COAST MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NORMAN DUANE STUTZNEGGER JR. (PRESIDENT/CEO)
(503) 338-0349
Entity
Organization
Contact information
Practice address
8080 E MILL PLAIN BLVD, VANCOUVER, WA 98664-2002
(360) 695-5161
(360) 695-2257
Mailing address
PO BOX 634, ASTORIA, OR 97103-0634
(360) 695-5161
(360) 695-2257
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
WA
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158971
—
OR
05
—
9046947
—
WA
Enumeration date
10/26/2007
Last updated
10/26/2007
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