Healthcare Provider Details

I. General information

NPI: 1386849271
Provider Name (Legal Business Name): PACIFIC MEDICAL EQUIPMENT SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SIX FORKS RD SUITE 130
RALEIGH NC
27609-7752
US

IV. Provider business mailing address

100 E SIX FORKS RD SUITE 130
RALEIGH NC
27609-7752
US

V. Phone/Fax

Practice location:
  • Phone: 919-881-8210
  • Fax: 919-832-1324
Mailing address:
  • Phone: 919-881-8210
  • Fax: 919-832-1324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01318
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CHUKWUEMEKA NWAKAMMA NJOKU
Title or Position: PRESIDENT
Credential:
Phone: 919-881-8210