Provider Demographics
NPI:1043495377
Name:SOUTH EASTERN MEDICAL SUPLIES,INC
Entity Type:Organization
Organization Name:SOUTH EASTERN MEDICAL SUPLIES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EZUMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-341-4468
Mailing Address - Street 1:1307 E MILLBROOK RD
Mailing Address - Street 2:SUITE C-23
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5476
Mailing Address - Country:US
Mailing Address - Phone:919-341-4468
Mailing Address - Fax:919-341-2378
Practice Address - Street 1:1307 E MILLBROOK RD
Practice Address - Street 2:SUITE C-23
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5476
Practice Address - Country:US
Practice Address - Phone:919-341-4468
Practice Address - Fax:919-341-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01375332B00000X, 332BC3200X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01375OtherNC BOARD OF PHARMACY