Healthcare Provider Details

I. General information

NPI: 1184763831
Provider Name (Legal Business Name): DIABETIC SUPPLIES OF AMERICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 OLD DIXIE HWY SUITE 3
LAKE PARK FL
33403-2361
US

IV. Provider business mailing address

802 OLD DIXIE HWY SUITE 3
LAKE PARK FL
33403-2361
US

V. Phone/Fax

Practice location:
  • Phone: 800-555-2561
  • Fax: 561-840-1042
Mailing address:
  • Phone: 800-555-2561
  • Fax: 561-840-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WARNER D HAWLEY
Title or Position: PRESIDENT
Credential:
Phone: 800-555-2561