Provider Demographics
NPI:1902372832
Name:POOL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:POOL MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-680-0560
Mailing Address - Street 1:323 NORTH PRAIRIE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INGELWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301
Mailing Address - Country:US
Mailing Address - Phone:310-680-0560
Mailing Address - Fax:310-680-0565
Practice Address - Street 1:323 NORTH PRAIRIE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INGELWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-680-0560
Practice Address - Fax:310-680-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies