Healthcare Provider Details

I. General information

NPI: 1730446147
Provider Name (Legal Business Name): MEDICAL EXPRESS DEPOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 &33 CASTLE COAKLEY
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 8
CHRISTIANSTED VI
00821-0008
US

V. Phone/Fax

Practice location:
  • Phone: 340-422-3389
  • Fax: 340-719-0301
Mailing address:
  • Phone: 340-422-3389
  • Fax: 340-719-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2150381L
License Number StateVI

VIII. Authorized Official

Name: MISS IRIS M SANTIAGO
Title or Position: PRESIDENT
Credential:
Phone: 340-422-3389