=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952349748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOICE MEDICAL SUPPLY COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1311 LONDONTOWN BLVD SUITE 130
-----------------------------------------------------
City | ELDERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-6454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-552-9595
-----------------------------------------------------
Fax | 410-552-9599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 LONDONTOWN BLVD SUITE 130
-----------------------------------------------------
City | ELDERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-6454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-552-9595
-----------------------------------------------------
Fax | 410-552-9599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT FOR PHARMACY SERVICE
-----------------------------------------------------
Name | MR. ARTHUR NORMAN RILEY
-----------------------------------------------------
Credential | MS PD
-----------------------------------------------------
Telephone | 410-552-9595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------