MEDICARE: ABUNDANTLY RICH MEDICAL SUPPLY LLC

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	:	1659200343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANTLY RICH MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	5719 ARCH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2419
Country	:	US
Telephone Number	:	215-430-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	5719 ARCH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2419
Country	:	US
Telephone Number	:	215-430-2686
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIERRA HATTEN-MCNEIL
Credential	:
Telephone Number	:	215-430-2686

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/19/2026

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