Organization
DIABETES SUPPLY CENTER OF THE MIDLANDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY RUSSALESI (CHIEF COMPLIANCE OFFICER)
(484) 246-9499
Entity
Organization
Contact information
Practice address
10304 CROWN POINT AVE, OMAHA, NE 68134-1060
(402) 399-8444
(402) 614-3850
Mailing address
10304 CROWN POINT AVE, OMAHA, NE 68134-1060
(402) 399-8444
(402) 614-3850
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0987867
—
IA
01
—
09931
BCBS
NE
01
—
2815035
NABP
NE
Enumeration date
08/03/2006
Last updated
07/03/2024
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