Provider Demographics
NPI:1306878905
Name:MCCORMICK MEDICAL DISTRIBUTION, INC.
Entity type:Organization
Organization Name:MCCORMICK MEDICAL DISTRIBUTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE/ OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-758-8749
Mailing Address - Street 1:635 PARADISE LANE
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4651
Mailing Address - Country:US
Mailing Address - Phone:425-778-4421
Mailing Address - Fax:425-776-2433
Practice Address - Street 1:635 PARADISE LANE
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4651
Practice Address - Country:US
Practice Address - Phone:425-778-4421
Practice Address - Fax:425-776-2433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PFM MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-06
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABL009364261QS1200X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
5325430001Medicare NSC