Organization
LIFELINE DIABETIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERRI SANDERSON (OWNER)
(662) 597-9200
Entity
Organization
Contact information
Practice address
201 3RD AVE N, SUITE 1, AMORY, MS 38821-3413
(662) 597-9200
(888) 918-2226
Mailing address
201 3RD AVE N, AMORY, MS 38821-3413
(662) 597-9200
(888) 918-2226
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
08376/02.0
MS
333600000X
Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2587977
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/29/2007
Last updated
08/28/2013
Update your record
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