Healthcare Provider Details

I. General information

NPI: 1922300144
Provider Name (Legal Business Name): MENAUL MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11415 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2435
US

IV. Provider business mailing address

11417 MENAUL BLVD NE
ALBUQUERQUE NM
87112-1794
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-1600
  • Fax: 505-291-1604
Mailing address:
  • Phone: 505-291-1600
  • Fax: 505-291-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD REZA ZAMANIAN
Title or Position: PHARMACIST/OWNER
Credential: DOCTOR OF PHARMACY
Phone: 505-291-1600