Healthcare Provider Details

I. General information

NPI: 1164326005
Provider Name (Legal Business Name): AXENA MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 COMMONWEALTH AVE STE 1
AUBURNDALE MA
02466-1909
US

IV. Provider business mailing address

2120 COMMONWEALTH AVE STE 1
AUBURNDALE MA
02466-1909
US

V. Phone/Fax

Practice location:
  • Phone: 833-450-2910
  • Fax: 857-335-9190
Mailing address:
  • Phone: 833-450-2910
  • Fax: 857-335-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNETTE BREWSTER
Title or Position: VP, COMMERCIAL OPERATIONS
Credential:
Phone: 339-221-1677