Healthcare Provider Details

I. General information

NPI: 1700349503
Provider Name (Legal Business Name): ROYAL MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 224K
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY STE 224K
COLUMBIA MD
21044-3264
US

V. Phone/Fax

Practice location:
  • Phone: 240-636-7342
  • Fax:
Mailing address:
  • Phone: 240-636-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARION MUKUNDANE
Title or Position: MANAGER
Credential: MD
Phone: 240-636-7342