| NPI | 1992799787 |
|---|---|
| Former Legal Business Name | LAKE DIABETES & MEDICAL SUPPLY, INC. |
| Entity Type | Organization |
| Authorized Contact | JOHN PEREIRA CEO 321-325-6047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2014-09-16 |