Provider Demographics
NPI:1326883752
Name:AVALON MEDICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:AVALON MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-425-8537
Mailing Address - Street 1:1800 W HAWTHORNE LN STE M2
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1860
Mailing Address - Country:US
Mailing Address - Phone:224-425-8537
Mailing Address - Fax:
Practice Address - Street 1:1800 W HAWTHORNE LN STE M2
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-1860
Practice Address - Country:US
Practice Address - Phone:224-425-8537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies