Provider Demographics
NPI:1245319755
Name:E Z HEALTH MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:E Z HEALTH MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-298-1247
Mailing Address - Street 1:4350 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-5027
Mailing Address - Country:US
Mailing Address - Phone:602-298-1247
Mailing Address - Fax:602-298-1248
Practice Address - Street 1:4350 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-5027
Practice Address - Country:US
Practice Address - Phone:602-298-1247
Practice Address - Fax:602-298-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5671720001Medicare NSC