Provider Demographics
NPI:1467936971
Name:MEND MEDICAL AND WELLNESS STORE, LLC
Entity Type:Organization
Organization Name:MEND MEDICAL AND WELLNESS STORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-650-1967
Mailing Address - Street 1:1063 DARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8133
Mailing Address - Country:US
Mailing Address - Phone:919-650-1967
Mailing Address - Fax:
Practice Address - Street 1:1063 DARRINGTON DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8133
Practice Address - Country:US
Practice Address - Phone:919-650-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies