Provider Demographics
NPI:1861710477
Name:ALPHA N-MEDICAL EQUIPMENT & SUPPLIES
Entity type:Organization
Organization Name:ALPHA N-MEDICAL EQUIPMENT & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:LEATHA
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-674-3408
Mailing Address - Street 1:103 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3617
Mailing Address - Country:US
Mailing Address - Phone:910-674-3408
Mailing Address - Fax:910-674-4343
Practice Address - Street 1:103 W 26TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3617
Practice Address - Country:US
Practice Address - Phone:910-674-3408
Practice Address - Fax:910-674-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01646332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01646OtherNORTH CAROLINA BOARD OF PHARMACY