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General NPI Number Information
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NPI Number | 1184763831
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Entity Type | Organization
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Legal Business Name | DIABETIC SUPPLIES OF AMERICA, INC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 802 OLD DIXIE HWY SUITE 3
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City | LAKE PARK
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State | FL
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Zip | 33403-2361
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Country | US
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Telephone | 800-555-2561
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Fax | 561-840-1042
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Provider Business Mailing Address
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Address Line | 802 OLD DIXIE HWY SUITE 3
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City | LAKE PARK
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State | FL
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Zip | 33403-2361
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Country | US
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Telephone | 800-555-2561
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Fax | 561-840-1042
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WARNER D HAWLEY
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Credential |
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Telephone | 800-555-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | FL
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