Provider Demographics
NPI:1871547406
Name:GENEREAL MEDICAL SUPPLY
Entity type:Organization
Organization Name:GENEREAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-546-3222
Mailing Address - Street 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:# 100
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-546-3222
Mailing Address - Fax:623-546-3246
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:# 100
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-546-3222
Practice Address - Fax:623-546-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20119477332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies