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General NPI Number Information
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NPI Number | 1417124496
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Entity Type | Organization
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Legal Business Name | DIABETES MANAGEMENT AND SUPPLIES
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 10 COMMERCE CT
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City | NEW ORLEANS
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State | LA
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Zip | 70123-3225
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Country | US
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Telephone | 888-738-7929
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Fax | 800-860-7201
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Provider Business Mailing Address
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Address Line | 220 W GERMANTOWN PIKE STE 250
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | WENDY RUSSALESI
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Credential |
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Telephone | 484-246-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5274IR
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License Number State | LA
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