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General NPI Number Information
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NPI Number | 1720117203
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Entity Type | Organization
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Legal Business Name | HARBOR MEDICAL SUPPLY
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 2917 W CAPITOL AVE
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-2910
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Country | US
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Telephone | 916-372-8766
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Fax | 916-372-1750
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Provider Business Mailing Address
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Address Line | 2917 W CAPITOL AVE
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-2910
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Country | US
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Telephone | 916-372-8766
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Fax | 916-372-1750
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. NELLY MERZHERITSKY
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Credential |
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Telephone | 415-336-9269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DME0218OF
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License Number State | CA
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