Provider Demographics
NPI:1225407042
Name:MYHEALTHSTORES LLC
Entity Type:Organization
Organization Name:MYHEALTHSTORES LLC
Other - Org Name:UROSTOMYDIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-496-3923
Mailing Address - Street 1:4416 COLUMBIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4575
Mailing Address - Country:US
Mailing Address - Phone:706-496-3923
Mailing Address - Fax:
Practice Address - Street 1:4416 COLUMBIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4575
Practice Address - Country:US
Practice Address - Phone:706-496-3923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7494190001Medicare NSC