Provider Demographics
NPI:1265631667
Name:WASHINGTON MEDICAL SUPPLY
Entity Type:Organization
Organization Name:WASHINGTON MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASSADOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:EDKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-296-6778
Mailing Address - Street 1:2487 E WASHINGTON BLVD # E
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2047
Mailing Address - Country:US
Mailing Address - Phone:626-296-6778
Mailing Address - Fax:626-296-8330
Practice Address - Street 1:2487 E WASHINGTON BLVD # E
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2047
Practice Address - Country:US
Practice Address - Phone:626-296-6778
Practice Address - Fax:626-296-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5958630001Medicare NSC