# MEDLIFE SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043827694
- **Authorized official:** RUSSELL JAMES INGRAM III (OWNER)
- **Authorized official phone:** (877) 401-2142

## Contact information

- **Practice address:** 1495 FOREST HILL BLVD STE C1, WEST PALM BEACH, FL 33406-6073
- **Practice address phone:** (877) 401-2142
- **Practice address fax:** (561) 770-3593
- **Mailing address:** 1495 FOREST HILL BLVD STE C1, WEST PALM BEACH, FL 33406-6073
- **Mailing address phone:** (877) 401-2142
- **Mailing address fax:** (561) 770-3593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 09/28/2020
- **Last updated:** 09/28/2020