Organization
LAKE DIABETES SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E. HENNESSY (PRESIDENT)
(321) 255-9800
Entity
Organization
Contact information
Practice address
508 N HARBOR CITY BLVD, MELBOURNE, FL 32935-6838
(321) 255-9800
(321) 751-1145
Mailing address
508 N HARBOR CITY BLVD, MELBOURNE, FL 32935-6838
(321) 255-9800
(321) 751-1145
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
11/05/2010
Last updated
11/05/2010
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