East Coast Diabetic Supply Inc

Primary specialty

Mail Order PharmacyTaxonomy code 3336M0002X

License

07232 Issued in NC

Legal business name

EAST COAST DIABETIC SUPPLY INC

Practice address

4030 Wendell Blvd
Wendell, NC 27591-6911

Phone

(919) 365-2993

Fax

(919) 365-3854

NPI assigned

Feb 14, 2006

Last updated

Jul 20, 2007By 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

Deborah Descoteaux

Title

Owner

Phone

(919) 365-2993

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1467426783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 68",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "275910068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 WENDELL BLVD",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "275916911",
            "telephone_number": "919-365-2993",
            "fax_number": "919-365-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST COAST DIABETIC SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "DESCOTEAUX",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-365-2993"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "NC",
            "license": "07232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3436222",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0515502",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3436222",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mail Order Pharmacy in Wendell, NC
• Providers in Wendell, NC by specialty
• Mail Order Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.