Provider Demographics
NPI:1922411727
Name:NADONAH MEDICAL SUPPLY
Entity Type:Organization
Organization Name:NADONAH MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IWUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-718-3870
Mailing Address - Street 1:44245 20TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4060
Mailing Address - Country:US
Mailing Address - Phone:661-718-3870
Mailing Address - Fax:661-902-0017
Practice Address - Street 1:44245 20TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4060
Practice Address - Country:US
Practice Address - Phone:661-718-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71423332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71423OtherHMDR