Provider Demographics
NPI:1992414494
Name:MEDICURE SUPPLY INC
Entity type:Organization
Organization Name:MEDICURE SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AQIB
Authorized Official - Middle Name:BIN
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-830-8334
Mailing Address - Street 1:3530 W PETERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3294
Mailing Address - Country:US
Mailing Address - Phone:224-830-8334
Mailing Address - Fax:
Practice Address - Street 1:3530 W PETERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3294
Practice Address - Country:US
Practice Address - Phone:224-830-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies