Provider Demographics
NPI:1306825724
Name:REXAM MEDICAL SUPPLY & DISTRIBUTION
Entity Type:Organization
Organization Name:REXAM MEDICAL SUPPLY & DISTRIBUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:REX
Authorized Official - Last Name:ANYAOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-323-0260
Mailing Address - Street 1:15225 SOUTH WESTERN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4327
Mailing Address - Country:US
Mailing Address - Phone:310-323-0260
Mailing Address - Fax:310-323-9224
Practice Address - Street 1:15225 SOUTH WESTERN AVE
Practice Address - Street 2:STE 101
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4327
Practice Address - Country:US
Practice Address - Phone:310-323-0260
Practice Address - Fax:310-323-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4885590001Medicare ID - Type Unspecified