Organization
PRESTIGE DIABETIC SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD PERRY JACKSON (PARTNER)
(803) 831-6778
Entity
Organization
Contact information
Practice address
6 EXECUTIVE CT, LAKE WYLIE, SC 29710-9338
(803) 831-6778
Mailing address
6 EXECUTIVE CT, LAKE WYLIE, SC 29710-9338
(803) 831-6778
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/10/2009
Last updated
07/10/2009
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