Provider Demographics
NPI:1528225752
Name:WELL CARE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:WELL CARE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDISSIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVEDISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-381-3565
Mailing Address - Street 1:127 S BRAND BLVD STE 100C
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1357
Mailing Address - Country:US
Mailing Address - Phone:818-381-3565
Mailing Address - Fax:818-241-0776
Practice Address - Street 1:127 S BRAND BLVD
Practice Address - Street 2:STE 100C
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1357
Practice Address - Country:US
Practice Address - Phone:818-381-3565
Practice Address - Fax:818-241-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies