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General NPI Number Information
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NPI Number | 1154451060
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Entity Type | Organization
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Legal Business Name | AZ DIABETIC SUPPLY INC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 386 MAPLE AVE E SUITE 113
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City | VIENNA
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State | VA
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Zip | 22180-4720
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Country | US
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Telephone | 877-883-0001
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Fax | 703-356-5516
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Provider Business Mailing Address
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Address Line | 386 MAPLE AVE E SUITE 113
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City | VIENNA
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State | VA
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Zip | 22180-4720
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Country | US
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Telephone | 877-883-0001
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Fax | 703-356-5516
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HISHAM ZAGHAL
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Credential |
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Telephone | 877-883-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 4434550001
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License Number State | VA
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