Provider Demographics
NPI:1174351712
Name:MLW MEDICAL SUPPLY STORE
Entity type:Organization
Organization Name:MLW MEDICAL SUPPLY STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-902-3452
Mailing Address - Street 1:9775 MILL CENTRE DR APT 431
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3970
Mailing Address - Country:US
Mailing Address - Phone:443-902-3452
Mailing Address - Fax:
Practice Address - Street 1:9775 MILL CENTRE DR APT 431
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3970
Practice Address - Country:US
Practice Address - Phone:443-902-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)