Provider Demographics
NPI:1821238767
Name:ALMA MEDICAL SUPPLIES & DISTRIBUTORS CORPORATION
Entity Type:Organization
Organization Name:ALMA MEDICAL SUPPLIES & DISTRIBUTORS CORPORATION
Other - Org Name:ALMA MEDICAL SUPPLIES & DISTRUBUTIV
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-371-2562
Mailing Address - Street 1:1490 W RINCON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9200
Mailing Address - Country:US
Mailing Address - Phone:951-371-2562
Mailing Address - Fax:951-371-2562
Practice Address - Street 1:1490 W RINCON ST
Practice Address - Street 2:SUITE E
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-9201
Practice Address - Country:US
Practice Address - Phone:951-371-2562
Practice Address - Fax:951-371-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4926950001Medicare NSC