Provider Demographics
NPI:1922300144
Name:MENAUL MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MENAUL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHARMACY
Authorized Official - Phone:505-291-1600
Mailing Address - Street 1:11417 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1794
Mailing Address - Country:US
Mailing Address - Phone:505-291-1600
Mailing Address - Fax:505-291-1604
Practice Address - Street 1:11415 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2435
Practice Address - Country:US
Practice Address - Phone:505-291-1600
Practice Address - Fax:505-291-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment