Diabetes Store, Incorporated

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DIABETES STORE, INCORPORATED

Doing business as

Diabetes Store, Inc.

Practice address

7165 Swinnea Rd
B-2
Southaven, MS 38671-6360

Phone

(662) 280-5533

Fax

(800) 208-0863

NPI assigned

Jul 18, 2008

Last updated

Nov 11, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Craig Brosseau

Title

Secretary

Phone

(952) 646-3255

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Diabetes Store, Inc. Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1235394206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 MORIAH WOODS BLVD",
            "address_2": "SUITE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381177128",
            "telephone_number": "901-312-3150",
            "fax_number": "800-208-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7165 SWINNEA RD",
            "address_2": "B-2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716360",
            "telephone_number": "662-280-5533",
            "fax_number": "800-208-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES STORE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "BROSSEAU",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-646-3255"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "4425570002",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05033718",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes Store, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandon Deterding, PHARM.D.
• Tyrel Detweiler, D.C.
• Mahfuz Mahin Dewan
• Jennifer Dewey, FNP
• DHP of Desoto Professional Association
• Sandra Dietle, LPC
• Jena Dimberg, MS CCC SLP
• Challandore Disorbo
• Diversicare of Southaven, LLC (Diversicare of Southaven)
• DLC Home Care Solutions

• Durable Medical Equipment & Medical Supplies in Southaven, MS
• Providers in Southaven, MS by specialty
• Durable Medical Equipment & Medical Supplies in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.