Provider Demographics
NPI:1336258169
Name:TOP FORM INC.
Entity Type:Organization
Organization Name:TOP FORM INC.
Other - Org Name:TOP FORM D/B/A A 2 Z HOME MEDICAL SUPPLIES
Other - Org Type:Doing Business As
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:910-484-0567
Mailing Address - Street 1:P O BOX 1594
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28402
Mailing Address - Country:US
Mailing Address - Phone:910-392-5553
Mailing Address - Fax:910-202-3236
Practice Address - Street 1:1708A OWEN DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-484-0567
Practice Address - Fax:910-484-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies