Healthcare Provider Details

I. General information

NPI: 1619128899
Provider Name (Legal Business Name): AMERICAN DIABETES WHOLESALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NW 34TH PL STE 35
POMPANO BEACH FL
33069-5928
US

IV. Provider business mailing address

2501 NW 34TH PL STE 35
POMPANO BEACH FL
33069-5928
US

V. Phone/Fax

Practice location:
  • Phone: 877-241-9002
  • Fax: 866-995-4820
Mailing address:
  • Phone: 877-241-9002
  • Fax: 866-995-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number332B00000X
License Number StateFL

VIII. Authorized Official

Name: MR. CHRIS MAGUIRE
Title or Position: VICE PRES
Credential:
Phone: 877-241-9002