Healthcare Provider Details

I. General information

NPI: 1891979837
Provider Name (Legal Business Name): LANETT MEDICAL SUPPLIES & SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 VALLEY PLAZA SHOPPING CTR
LANETT AL
36863-2075
US

IV. Provider business mailing address

119 VALLEY PLAZA SHOPPING CENTER
LANETT AL
36863
US

V. Phone/Fax

Practice location:
  • Phone: 334-642-1524
  • Fax: 334-642-1526
Mailing address:
  • Phone: 334-642-1524
  • Fax: 334-642-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO BENS VEGA
Title or Position: PRESIDENT
Credential:
Phone: 334-642-1524