Organization
GRASSROOTS MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON MICHAEL LESTER (OWNER)
(928) 421-5201
Entity
Organization
Contact information
Practice address
NEC NAVAJO ROUTE 15 AND 60, SUITE #2, WINLSOW, AZ 86047
(928) 421-5201
Mailing address
28 N. HIGHWAY 77, PMB 5105, HOLBROOK, AZ 86025
(928) 421-5201
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
09/08/2017
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