Provider Demographics
NPI:1851797880
Name:PACIFIC BIOMEDICAL DISTRIBUTION SERVICES CORP
Entity Type:Organization
Organization Name:PACIFIC BIOMEDICAL DISTRIBUTION SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:HANNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-967-3652
Mailing Address - Street 1:3140 GOLD CAMP DR
Mailing Address - Street 2:SUITE 90
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6023
Mailing Address - Country:US
Mailing Address - Phone:916-967-3652
Mailing Address - Fax:916-967-3652
Practice Address - Street 1:3140 GOLD CAMP DR
Practice Address - Street 2:SUITE 90
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6023
Practice Address - Country:US
Practice Address - Phone:916-967-3652
Practice Address - Fax:916-967-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1817913332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies