Provider Demographics
NPI:1497273585
Name:WILLISTON HEALTH SUPPLIES
Entity Type:Organization
Organization Name:WILLISTON HEALTH SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMININSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-768-0272
Mailing Address - Street 1:34 BLAIR PARK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7991
Mailing Address - Country:US
Mailing Address - Phone:802-768-0272
Mailing Address - Fax:
Practice Address - Street 1:34 BLAIR PARK ROAD, SUITE 104 #302
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-768-0272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies