Provider Demographics
NPI:1649539578
Name:PEERLESS MEDICAL INC
Entity type:Organization
Organization Name:PEERLESS MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SHLONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-409-6003
Mailing Address - Street 1:10 BUIST RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9311
Mailing Address - Country:US
Mailing Address - Phone:570-409-6003
Mailing Address - Fax:570-409-6063
Practice Address - Street 1:10 BUIST RD STE 305
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9311
Practice Address - Country:US
Practice Address - Phone:570-409-6003
Practice Address - Fax:570-409-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-13
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135222OtherPK