Healthcare Provider Details

I. General information

NPI: 1730137951
Provider Name (Legal Business Name): NORTH AMERICAN HOME HEALTH SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16129 COHASSET ST
VAN NUYS CA
91406-2908
US

IV. Provider business mailing address

PO BOX 637299
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-3757
  • Fax: 800-531-3344
Mailing address:
  • Phone: 800-218-5604
  • Fax: 631-249-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50164
License Number StateCA

VIII. Authorized Official

Name: RUSSELL FICHERA
Title or Position: SR. VP, TREASURER
Credential: RPH
Phone: 631-870-5100