Organization
MEDICAL DEPOT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY R. RAYNER (OWNER)
(601) 480-6509
Entity
Organization
Contact information
Practice address
4969 HIGHWAY 28, MIZE, MS 39116-5355
(601) 480-6509
Mailing address
4969 HWY 28, MIZE, MS 39116
(601) 480-6509
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MS
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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