Healthcare Provider Details

I. General information

NPI: 1265631667
Provider Name (Legal Business Name): WASHINGTON MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 E WASHINGTON BLVD # E
PASADENA CA
91104-2047
US

IV. Provider business mailing address

2487 E WASHINGTON BLVD # E
PASADENA CA
91104-2047
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-6778
  • Fax: 626-296-8330
Mailing address:
  • Phone: 626-296-6778
  • Fax: 626-296-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ASSADOUR EDKARIAN
Title or Position: PRESDENT
Credential:
Phone: 626-296-6778