Healthcare Provider Details

I. General information

NPI: 1184552143
Provider Name (Legal Business Name): PITTSBURG MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2283 RAILROAD AVE
PITTSBURG CA
94565-4924
US

IV. Provider business mailing address

3710 LONE TREE WAY STE 150
ANTIOCH CA
94509-6018
US

V. Phone/Fax

Practice location:
  • Phone: 925-966-9797
  • Fax:
Mailing address:
  • Phone: 925-966-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SHANNON TYLER SMITH
Title or Position: PRESIDENT
Credential:
Phone: 925-966-9797