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Organization
DIABETES STORE, INCORPORATED
Active
Organization
DIABETES STORE, INCORPORATED
Active
Other names
Diabetes and Respiratory Store, The Diabetes and Respiratory Store
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG BROSSEAU (SECRETARY)
(952) 646-3255
Entity
Organization
Contact information
Practice address
1760 MORIAH WOODS BLVD, SUITE 2, MEMPHIS, TN 38117-7128
(901) 312-3150
(800) 208-0683
Mailing address
1760 MORIAH WOODS BLVD, SUITE 2, MEMPHIS, TN 38117-7128
(901) 312-3150
(800) 208-0863
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
0000004074
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4437643
NCPDP
TN
Enumeration date
01/25/2007
Last updated
11/11/2022
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