Provider Demographics
NPI:1326589367
Name:CHARLESTON MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:CHARLESTON MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZEESHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-693-2754
Mailing Address - Street 1:3501 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1419
Mailing Address - Country:US
Mailing Address - Phone:304-693-2754
Mailing Address - Fax:844-367-0015
Practice Address - Street 1:3501 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1419
Practice Address - Country:US
Practice Address - Phone:304-693-2754
Practice Address - Fax:844-367-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies