Provider Demographics
NPI:1316944606
Name:DIABETIC WAREHOUSE, LLC
Entity type:Organization
Organization Name:DIABETIC WAREHOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-474-5972
Mailing Address - Street 1:4417 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4311
Mailing Address - Country:US
Mailing Address - Phone:337-474-5972
Mailing Address - Fax:337-479-0485
Practice Address - Street 1:4417 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4311
Practice Address - Country:US
Practice Address - Phone:337-474-5972
Practice Address - Fax:337-479-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1469866Medicaid
LA1469866Medicaid
LA=========0OtherBLUE CROSS BLUE SHIELD