Healthcare Provider Details

I. General information

NPI: 1093630220
Provider Name (Legal Business Name): PROHEALTH SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HANCOCK ST STE 203
QUINCY MA
02169-5230
US

IV. Provider business mailing address

1515 HANCOCK ST STE 203
QUINCY MA
02169-5230
US

V. Phone/Fax

Practice location:
  • Phone: 617-729-2614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: VAIBHAV RUPAPARA
Title or Position: PRESIDENT
Credential:
Phone: 617-729-2614