| NPI | 1083600910 |
|---|---|
| Other Name | DIABETES SHOPPE |
| Entity Type | Organization |
| Authorized Contact | ROBERT A ROSEN President Pharmacist In Charge 870-534-8351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AR 140255716) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: AR 04d0983574 clia) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AR 100103407) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2010-04-07 |