Provider Demographics
NPI:1326179979
Name:ALLIED MED WHOLESALE
Entity type:Organization
Organization Name:ALLIED MED WHOLESALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-855-0475
Mailing Address - Street 1:8909 W OLYMPIC BLVD
Mailing Address - Street 2:#208
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3551
Mailing Address - Country:US
Mailing Address - Phone:310-855-0475
Mailing Address - Fax:310-855-0477
Practice Address - Street 1:8909 W OLYMPIC BLVD
Practice Address - Street 2:#208
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3551
Practice Address - Country:US
Practice Address - Phone:310-855-0475
Practice Address - Fax:310-855-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWLS54594332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site