# MEDEX SUPPLY INC

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

## Provider details

- **NPI number:** 1629927686
- **Authorized official:** SHARIFKHON SIRODZHOV (PRESIDENT)
- **Authorized official phone:** (747) 343-9575

## Contact information

- **Practice address:** 16442 VANOWEN ST, LAKE BALBOA, CA 91406-4729
- **Practice address phone:** (747) 343-9575
- **Mailing address:** 16442 VANOWEN ST, LAKE BALBOA, CA 91406-4729
- **Mailing address phone:** (747) 343-9575

## Taxonomy

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

## Other

- **Enumeration date:** 01/23/2026
- **Last updated:** 01/23/2026