Provider Demographics
NPI:1598750010
Name:TOP FORM INC.
Entity Type:Organization
Organization Name:TOP FORM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-392-5806
Mailing Address - Street 1:PO BOX 1594
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28402-1594
Mailing Address - Country:US
Mailing Address - Phone:910-392-5806
Mailing Address - Fax:910-452-2913
Practice Address - Street 1:1731 DAWSON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2326
Practice Address - Country:US
Practice Address - Phone:910-392-5806
Practice Address - Fax:910-452-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
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
NC045X2OtherBLUE CROSS AND BLUE SHIEL
NC045X2OtherBLUE CROSS AND BLUE SHIEL