Organization
DIABETIC SUPPLY SOURCE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SHUFORD (OWNER)
(803) 799-3505
Entity
Organization
Contact information
Practice address
2805 MILLWOOD AVE, COLUMBIA, SC 29205-1298
(803) 799-3505
(803) 256-1083
Mailing address
PO BOX 25534, COLUMBIA, SC 29224-5534
(803) 799-3505
(803) 256-1083
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
50-008619
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4226292
NCPDP
SC
01
—
50-008619
PHARMACY PERMIT NUMBER
SC
05
—
786194
—
SC
Enumeration date
02/21/2007
Last updated
08/22/2020
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