Healthcare Provider Details

I. General information

NPI: 1467426783
Provider Name (Legal Business Name): EAST COAST DIABETIC SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 WENDELL BLVD
WENDELL NC
27591-6911
US

IV. Provider business mailing address

PO BOX 68
WENDELL NC
27591-0068
US

V. Phone/Fax

Practice location:
  • Phone: 919-365-2993
  • Fax: 919-365-3854
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number07232
License Number StateNC

VIII. Authorized Official

Name: DEBORAH DESCOTEAUX
Title or Position: OWNER
Credential:
Phone: 919-365-2993