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General NPI Number Information
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NPI Number | 1952580953
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 8080 E MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98664-2002
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Country | US
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Telephone | 360-695-5161
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Fax | 360-695-2257
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Provider Business Mailing Address
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Address Line | PO BOX 634
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City | ASTORIA
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State | OR
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Zip | 97103-0634
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Country | US
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Telephone | 360-695-5161
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Fax | 360-695-2257
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. NORMAN DUANE STUTZNEGGER JR.
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Credential |
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Telephone | 503-338-0349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | WA
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