Provider Demographics
NPI:1699876573
Name:SAINT BENEDICT MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:SAINT BENEDICT MEDICAL SUPPLY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENEDICT
Authorized Official - Middle Name:TOLULANI
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-386-6528
Mailing Address - Street 1:1324 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5919
Mailing Address - Country:US
Mailing Address - Phone:707-399-9090
Mailing Address - Fax:
Practice Address - Street 1:1324 TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5919
Practice Address - Country:US
Practice Address - Phone:707-399-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46170332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46170OtherHMDR RETAIL LICENSE