Organization
DIABETES STORE, INCORPORATED
Active
Other names
Diabetes Store, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG BROSSEAU (SECRETARY)
(952) 646-3255
Entity
Organization
Contact information
Practice address
7165 SWINNEA RD, B-2, SOUTHAVEN, MS 38671-6360
(662) 280-5533
(800) 208-0863
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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05033718
—
MS
01
—
4425570002
MEDICARE
MS
Enumeration date
07/18/2008
Last updated
11/11/2022
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