Organization
ACTIVE LIVING STORE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAGE R. WHITTLE (VICE PRESIDENT)
(352) 307-3511
Entity
Organization
Contact information
Practice address
17860 SE 109TH AVE, #630, SUMMERFIELD, FL 34491-8911
(352) 307-3511
(352) 307-1151
Mailing address
PO BOX 492936, LEESBURG, FL 34749-2936
(352) 307-3511
(352) 307-1151
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1626
FL
Other
Enumeration date
02/07/2007
Last updated
08/22/2020
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