Healthcare Provider Details

I. General information

NPI: 1972529451
Provider Name (Legal Business Name): DIABETES STORE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 MORIAH WOODS BLVD SUITE 2
MEMPHIS TN
38117-7128
US

IV. Provider business mailing address

1760 MORIAH WOODS BLVD SUITE 2
MEMPHIS TN
38117-7128
US

V. Phone/Fax

Practice location:
  • Phone: 901-312-3150
  • Fax: 800-208-0863
Mailing address:
  • Phone: 901-312-3150
  • Fax: 901-312-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TOSHIO SERIZAWA
Title or Position: PRESIDENT
Credential:
Phone: 612-709-4079