Healthcare Provider Details

I. General information

NPI: 1942497813
Provider Name (Legal Business Name): HEALTHCARE DEPOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8624 CORY DR
BOWIE MD
20720-4461
US

IV. Provider business mailing address

8624 CORY DR
BOWIE MD
20720-4461
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-7970
  • Fax: 301-809-9314
Mailing address:
  • Phone: 301-805-7970
  • Fax: 301-809-9314

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: PAT E MENSAH
Title or Position: CEO
Credential:
Phone: 301-805-7970