# DIABETES SUPPLY CENTER OF THE MIDLANDS LLC

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

## Provider details

- **NPI number:** 1992713481
- **Authorized official:** WENDY RUSSALESI (CHIEF COMPLIANCE OFFICER)
- **Authorized official phone:** (484) 246-9499

## Contact information

- **Practice address:** 10304 CROWN POINT AVE, OMAHA, NE 68134-1060
- **Practice address phone:** (402) 399-8444
- **Practice address fax:** (402) 614-3850
- **Mailing address:** 10304 CROWN POINT AVE, OMAHA, NE 68134-1060
- **Mailing address phone:** (402) 399-8444
- **Mailing address fax:** (402) 614-3850

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 07/03/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0987867 | — | IA |
| 01 | — | 09931 | BCBS | NE |
| 01 | — | 2815035 | NABP | NE |