# COMPLETE DIABETES PHARMACY CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Complete Diabetes Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619396892
- **Authorized official:** CRAIG BROSSEAU (SECRETARY)
- **Authorized official phone:** (952) 646-3255

## Contact information

- **Practice address:** 7165 SWINNEA RD, BLDG B-2, SOUTHAVEN, MS 38671-6360
- **Practice address phone:** (662) 280-5533
- **Practice address fax:** (800) 208-0863
- **Mailing address:** 7165 SWINNEA RD, BUILDING B-2, SOUTHAVEN, MS 38671-6360
- **Mailing address phone:** (662) 280-5533
- **Mailing address fax:** (800) 208-0863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 13340 | MS | Yes |

## Other

- **Enumeration date:** 04/15/2014
- **Last updated:** 11/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2145616 | PK | — |