Provider Demographics
NPI:1124562814
Name:MEDICAL SUPPLIES & UNIFORMS-HEALTHCARE DEPOT LLC
Entity Type:Organization
Organization Name:MEDICAL SUPPLIES & UNIFORMS-HEALTHCARE DEPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-657-0457
Mailing Address - Street 1:8062 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2407
Mailing Address - Country:US
Mailing Address - Phone:763-657-0457
Mailing Address - Fax:
Practice Address - Street 1:8062 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2407
Practice Address - Country:US
Practice Address - Phone:763-657-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies