Provider Demographics
NPI:1124581053
Name:CAPITOL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:CAPITOL MEDICAL SUPPLY INC
Other - Org Name:CAPITOL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMERIA AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-247-8165
Mailing Address - Street 1:3629 N SEPULVEDA BLVD # 103
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3632
Mailing Address - Country:US
Mailing Address - Phone:424-247-8165
Mailing Address - Fax:
Practice Address - Street 1:3629 N SEPULVEDA BLVD # 103
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3632
Practice Address - Country:US
Practice Address - Phone:424-247-8165
Practice Address - Fax:424-247-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies