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General NPI Number Information
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NPI Number | 1942582572
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Entity Type | Organization
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Legal Business Name | C&M MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 8600 S WILKINSON WAY SUITE C
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City | PERRYSBURG
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State | OH
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Zip | 43551-2598
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Country | US
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Telephone | 419-872-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 S WILKINSON WAY SUITE C
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City | PERRYSBURG
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State | OH
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Zip | 43551-2598
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Country | US
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Telephone | 419-872-0033
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CRESTON TARRANT
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Credential |
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Telephone | 419-872-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 022147200
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License Number State | OH
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