Healthcare Provider Details

I. General information

NPI: 1386921021
Provider Name (Legal Business Name): AUSTIN'S MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10757 YORK RD
COCKEYSVILLE MD
21030-2114
US

IV. Provider business mailing address

6729 YORK RD
BALTIMORE MD
21212-1806
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-5300
  • Fax:
Mailing address:
  • Phone: 410-377-5300
  • Fax: 410-377-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number03424060
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number03424060
License Number StateMD

VIII. Authorized Official

Name: DONNA WOLK
Title or Position: OWNER
Credential:
Phone: 410-377-5300