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Organization

MED LEAF SUPPLY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VAKHTANA TKHILISHVILI (PRESIDENT)
(343) 983-3320
Entity
Organization

Contact information

Practice address
3342 W HILLSBORO BLVD, DEERFIELD BEACH, FL 33442-9403
(312) 215-0062
Mailing address
3342 W HILLSBORO BLVD, DEERFIELD BEACH, FL 33442-9403
(312) 215-0062

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Enumeration date
04/23/2021
Last updated
04/23/2021
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