Provider Demographics
NPI:1679611073
Name:A & M MEDICAL SUPPLY & PHARMACY
Entity Type:Organization
Organization Name:A & M MEDICAL SUPPLY & PHARMACY
Other - Org Name:A & M CAPITOL VENTURES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRERS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALPHONSO
Authorized Official - Middle Name:LAWAYN
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:301-839-0158
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:STE 130
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-839-0158
Mailing Address - Fax:301-839-5747
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:STE 130
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-839-0158
Practice Address - Fax:301-839-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11810443332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5455110001Medicare ID - Type Unspecified