Provider Demographics
NPI:1730307711
Name:PREMIUM MEDICAL SUPPLIES & SERVICES
Entity type:Organization
Organization Name:PREMIUM MEDICAL SUPPLIES & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUMBIKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-497-7222
Mailing Address - Street 1:316 TALBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4334
Mailing Address - Country:US
Mailing Address - Phone:301-497-7222
Mailing Address - Fax:301-497-7225
Practice Address - Street 1:316 TALBOTT AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4334
Practice Address - Country:US
Practice Address - Phone:301-497-7222
Practice Address - Fax:301-497-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2541332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies