Provider Demographics
NPI:1770025124
Name:1ST ADULT&PEDIATRIC MEDICAL SUPPLIESLLC
Entity Type:Organization
Organization Name:1ST ADULT&PEDIATRIC MEDICAL SUPPLIESLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRYANT-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-416-1272
Mailing Address - Street 1:10650 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3814
Mailing Address - Country:US
Mailing Address - Phone:240-416-1272
Mailing Address - Fax:
Practice Address - Street 1:10650 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3814
Practice Address - Country:US
Practice Address - Phone:240-416-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies