Provider Demographics
NPI:1346296308
Name:FREEPORT MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:FREEPORT MEDICAL SUPPLY INC
Other - Org Name:XTRA CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:516-208-7432
Mailing Address - Street 1:75 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3841
Mailing Address - Country:US
Mailing Address - Phone:516-208-7432
Mailing Address - Fax:516-208-8096
Practice Address - Street 1:75 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3841
Practice Address - Country:US
Practice Address - Phone:516-208-7432
Practice Address - Fax:516-208-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3354684OtherNABP
NY3354684OtherNABP