Provider Demographics
NPI:1154451060
Name:AZ DIABETIC SUPPLY INC
Entity Type:Organization
Organization Name:AZ DIABETIC SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-883-0001
Mailing Address - Street 1:386 MAPLE AVE E
Mailing Address - Street 2:SUITE 113
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4720
Mailing Address - Country:US
Mailing Address - Phone:877-883-0001
Mailing Address - Fax:703-356-5516
Practice Address - Street 1:386 MAPLE AVE E
Practice Address - Street 2:SUITE 113
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4720
Practice Address - Country:US
Practice Address - Phone:877-883-0001
Practice Address - Fax:703-356-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4434550001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4434550001Medicare NSC