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General NPI Number Information
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NPI Number | 1740473354
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Entity Type | Organization
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Legal Business Name | SPACE COAST DISCOUNT DIABETIC SUPPLIES, INC.
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 3720 CURTIS BLVD SUITE 104
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City | COCOA
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State | FL
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Zip | 32927-3961
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Country | US
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Telephone | 321-305-5908
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Fax | 321-305-5911
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | SHARPES
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State | FL
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Zip | 32959-0688
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Country | US
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Telephone | 321-305-5908
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Fax | 321-305-5911
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN VEAUDRY
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Credential |
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Telephone | 321-305-5908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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