# ACTIVE LIVING STORE INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871633073
- **Authorized official:** MR. PAGE R. WHITTLE (VICE PRESIDENT)
- **Authorized official phone:** (352) 307-3511

## Contact information

- **Practice address:** 17860 SE 109TH AVE, \#630, SUMMERFIELD, FL 34491-8911
- **Practice address phone:** (352) 307-3511
- **Practice address fax:** (352) 307-1151
- **Mailing address:** PO BOX 492936, LEESBURG, FL 34749-2936
- **Mailing address phone:** (352) 307-3511
- **Mailing address fax:** (352) 307-1151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1626 | FL | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 08/22/2020