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Organization
FAMILY MEDICAL SUPPLY LLC
Active
Organization
FAMILY MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY RUSSALESI (CCO)
(484) 246-9499
Entity
Organization
Contact information
Practice address
301 WESTERN BLVD STE D, JACKSONVILLE, NC 28546-6302
(910) 356-2145
(910) 455-2533
Mailing address
555 E NORTH LN STE 5075, CONSHOHOCKEN, PA 19428-2490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332BC3200X
Customized Equipment (DME)
—
NULL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
NULL
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
01053
NC
Other
Enumeration date
07/11/2006
Last updated
07/24/2026
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