Provider Demographics
NPI:1427050442
Name:DIABETIC SUPPLIES COM INC
Entity type:Organization
Organization Name:DIABETIC SUPPLIES COM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA, CPED
Authorized Official - Phone:360-723-9002
Mailing Address - Street 1:2210 W MAIN ST
Mailing Address - Street 2:SUITE 107-388
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4236
Mailing Address - Country:US
Mailing Address - Phone:360-723-9001
Mailing Address - Fax:360-723-9030
Practice Address - Street 1:107 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-3122
Practice Address - Country:US
Practice Address - Phone:360-723-9001
Practice Address - Fax:360-723-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602049047332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306350001Medicare NSC