Provider Demographics
NPI:1417126780
Name:WNC MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:WNC MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-335-8744
Mailing Address - Street 1:3705 BEACON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1467
Mailing Address - Country:US
Mailing Address - Phone:510-796-5555
Mailing Address - Fax:510-796-7044
Practice Address - Street 1:3705 BEACON AVE STE 200
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1467
Practice Address - Country:US
Practice Address - Phone:510-796-5555
Practice Address - Fax:510-796-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier