Provider Demographics
NPI:1629247135
Name:ALHAMBRA MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ALHAMBRA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYK
Authorized Official - Middle Name:
Authorized Official - Last Name:PODRUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-282-7200
Mailing Address - Street 1:1300 E MAIN ST
Mailing Address - Street 2:107
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4149
Mailing Address - Country:US
Mailing Address - Phone:626-282-7200
Mailing Address - Fax:626-282-7201
Practice Address - Street 1:1300 E MAIN ST
Practice Address - Street 2:107
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4149
Practice Address - Country:US
Practice Address - Phone:626-282-7200
Practice Address - Fax:626-282-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48980332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6082030001Medicare NSC