MEDICARE: ALLIED MED WHOLESALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	WLS54594	CA

General Provider Information

NPI Number	:	1326179979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED MED WHOLESALE

Provider Business Mailing Address
First Line	:	8909 W OLYMPIC BLVD
Second Line	:	#208
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3551
Country	:	US
Telephone Number	:	310-855-0475
Fax Number	:	310-855-0477

Provider Business Practice Location Address
First Line	:	8909 W OLYMPIC BLVD
Second Line	:	#208
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3551
Country	:	US
Telephone Number	:	310-855-0475
Fax Number	:	310-855-0477

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JACK AMIN
Credential	:
Telephone Number	:	310-855-0475

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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Directions to “ALLIED MED WHOLESALE ” Practice Location

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