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General NPI Number Information
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NPI Number | 1437359676
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Entity Type | Organization
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Legal Business Name | I&M GRAND MEDICAL SUPPLIES
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 5826 W OLIVE AVE STE 102
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City | GLENDALE
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State | AZ
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Zip | 85302-3153
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Country | US
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Telephone | 623-934-3752
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Fax | 623-934-3725
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Provider Business Mailing Address
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Address Line | 5826 W OLIVE AVE STE 102
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City | GLENDALE
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State | AZ
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Zip | 85302-3153
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Country | US
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Telephone | 623-934-3752
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Fax | 623-934-3725
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Authorized Official
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Title or Position | OWNER
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Name | MR. IVAN MANUCHARYAN
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Credential |
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Telephone | 623-934-3752
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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 | 20174034
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License Number State | AZ
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