Provider Demographics
NPI:1376186999
Name:MAMA & ROOS SUPPLEMENT CO
Entity Type:Organization
Organization Name:MAMA & ROOS SUPPLEMENT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUPPELO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, AAHCC
Authorized Official - Phone:717-814-8538
Mailing Address - Street 1:3435 CONCORD RD OFC # 22094
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-1104
Mailing Address - Country:US
Mailing Address - Phone:717-814-8538
Mailing Address - Fax:
Practice Address - Street 1:2555 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4966
Practice Address - Country:US
Practice Address - Phone:717-814-8538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies