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General NPI Number Information
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NPI Number | 1437932712
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Entity Type | Organization
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Legal Business Name | AQUAMED SUPPLY LLC
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 111 E MONUMENT AVE UNIT 407
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City | KISSIMMEE
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State | FL
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Zip | 34741-5774
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Country | US
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Telephone | 888-533-4794
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E MONUMENT AVE UNIT 407
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City | KISSIMMEE
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State | FL
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Zip | 34741-5774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARQUES GREEN
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Credential |
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Telephone | 407-927-2094
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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 |
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License Number State |
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