| NPI | 1366436107 |
|---|---|
| Former Legal Business Name | LAKE DIABETES & MEDICAL SUPPLY, INC. |
| Entity Type | Organization |
| Authorized Contact | MICHAEL E HENNESSY President 321-255-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2022-07-21 |