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General NPI Number Information
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NPI Number | 1326439027
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Entity Type | Organization
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Legal Business Name | MEDICAL SUPPLY DEPOT
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 2662 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-1307
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Country | US
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Telephone | 773-868-3994
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Fax |
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Provider Business Mailing Address
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Address Line | 2662 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-1307
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Country | US
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Telephone | 773-868-3994
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HINA CHOWDHRY
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Credential |
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Telephone | 260-418-8050
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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 | 1475809472
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License Number State | IL
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