Healthcare Provider Details

I. General information

NPI: 1508719352
Provider Name (Legal Business Name): GRAYMED SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ABBOTT DR STE U
BROOMALL PA
19008-4320
US

IV. Provider business mailing address

501 ABBOTT DR STE U
BROOMALL PA
19008-4320
US

V. Phone/Fax

Practice location:
  • Phone: 347-223-7593
  • Fax:
Mailing address:
  • Phone: 347-223-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEVON GRAY
Title or Position: OWNER
Credential:
Phone: 347-223-7593