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NPI Code Detail

MEDICARE: DIABETIC SUPPLIES COM INC

MEDICARE: DIABETIC SUPPLIES COM INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies602049047WA

General Provider Information

NPI Number : 1427050442
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIABETIC SUPPLIES COM INC
Provider Business Mailing Address
First Line : 2210 W MAIN ST
Second Line : SUITE 107-388
City : BATTLE GROUND
State : WA
Zip : 98604-4236
Country : US
Telephone Number : 360-723-9001
Fax Number : 360-723-9030
Provider Business Practice Location Address
First Line : 107 SW 13TH AVE
Second Line :
City : BATTLE GROUND
State : WA
Zip : 98604-3122
Country : US
Telephone Number : 360-723-9001
Fax Number : 360-723-9030
Authorized Official
Title or Position : PRESIDENT CEO
Name : MS. PAMELA KAY LUNA
Credential : COTA, CPED
Telephone Number : 360-723-9002
Provider Enumeration Date : 08/10/2005
Last Update Date : 01/05/2015

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Directions to “DIABETIC SUPPLIES COM INC ” Practice Location

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