MEDICARE: DIABETIC SUPPLIES COM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	602049047	WA

General Provider Information

NPI Number	:	1427050442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC SUPPLIES COM INC

Provider Business Mailing Address
First Line	:	2210 W MAIN ST
Second Line	:	SUITE 107-388
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4236
Country	:	US
Telephone Number	:	360-723-9001
Fax Number	:	360-723-9030

Provider Business Practice Location Address
First Line	:	107 SW 13TH AVE
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-3122
Country	:	US
Telephone Number	:	360-723-9001
Fax Number	:	360-723-9030

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MS. PAMELA KAY LUNA
Credential	:	COTA, CPED
Telephone Number	:	360-723-9002

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/05/2015

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