Provider Demographics
NPI:1316726326
Name:SMART DIABETES SUPPLY LLC
Entity type:Organization
Organization Name:SMART DIABETES SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:VAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-558-0922
Mailing Address - Street 1:1881 NE 26TH ST STE 238
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1426
Mailing Address - Country:US
Mailing Address - Phone:954-790-6980
Mailing Address - Fax:954-790-6980
Practice Address - Street 1:1881 NE 26TH ST STE 238
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1426
Practice Address - Country:US
Practice Address - Phone:954-790-6980
Practice Address - Fax:954-790-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies