Provider Demographics
NPI:1669949707
Name:NORCAL MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:NORCAL MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERIAN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-769-9606
Mailing Address - Street 1:PO BOX 4495
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94955-4495
Mailing Address - Country:US
Mailing Address - Phone:707-769-9606
Mailing Address - Fax:707-776-4659
Practice Address - Street 1:620 PETALUMA BLVD N STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2870
Practice Address - Country:US
Practice Address - Phone:707-769-9606
Practice Address - Fax:707-776-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies