MEDICARE: DESTINY MEDICAL AND JANITORIAL SUPPLIES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1063291292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY MEDICAL AND JANITORIAL SUPPLIES INC.

Provider Business Mailing Address
First Line	:	32455 W 12 MILE RD UNIT 3004
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48333-7142
Country	:	US
Telephone Number	:	888-320-0919
Fax Number	:	248-702-6193

Provider Business Practice Location Address
First Line	:	32455 W 12 MILE RD UNIT 3004
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48333-7142
Country	:	US
Telephone Number	:	888-320-0919
Fax Number	:	248-702-6193

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN CANNON
Credential	:
Telephone Number	:	888-320-0919

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	09/26/2023

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