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General NPI Number Information
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NPI Number | 1750326096
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Entity Type | Organization
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Legal Business Name | ADELCO MEDICAL DISTRIBUTORS INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 15223 SO .CRENSHAW BLVD # B
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City | GARDENA
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State | CA
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Zip | 90249-4048
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Country | US
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Telephone | 310-856-4701
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Fax | 310-856-4705
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Provider Business Mailing Address
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Address Line | PO BOX 895
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City | HAWTHORNE
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State | CA
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Zip | 90251
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Country | US
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Telephone | 310-856-4701
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Fax | 310-856-4705
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Authorized Official
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Title or Position | CEO
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Name | ADELINE EKWEBELEM
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Credential |
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Telephone | 310-856-4701
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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 | 101427
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License Number State | CA
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