Provider Demographics
NPI:1396129292
Name:A&J MEDCARE SUPPLIES
Entity type:Organization
Organization Name:A&J MEDCARE SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOLEDO LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-613-1032
Mailing Address - Street 1:4692 S SUNSTONE RD
Mailing Address - Street 2:158
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-3644
Mailing Address - Country:US
Mailing Address - Phone:801-613-1032
Mailing Address - Fax:
Practice Address - Street 1:4692 S SUNSTONE RD
Practice Address - Street 2:158
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-3644
Practice Address - Country:US
Practice Address - Phone:801-613-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies