Healthcare Provider Details

I. General information

NPI: 1801060173
Provider Name (Legal Business Name): ADMIRAL MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CROSSPOINT BLVD STE 250
INDIANAPOLIS IN
46256
US

IV. Provider business mailing address

10475 CROSSPOINT BLVD STE 250
INDIANAPOLIS IN
46256-3387
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-7730
  • Fax: 317-545-1877
Mailing address:
  • Phone: 317-296-7730
  • Fax: 317-545-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. RASHARD GRAVES
Title or Position: PRESIDENT
Credential:
Phone: 317-296-7730