Diabetes Store, Incorporated

Primary specialty

PharmacyTaxonomy code 333600000X

License

0000004074 Issued in TN

Legal business name

DIABETES STORE, INCORPORATED

Doing business as

Diabetes and Respiratory Store
The Diabetes and Respiratory Store

Practice address

1760 Moriah Woods Blvd
Suite 2
Memphis, TN 38117-7128

Phone

(901) 312-3150

Fax

(800) 208-0683

NPI assigned

Jan 25, 2007

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 1

Other names 2

• Diabetes and Respiratory Store Doing business as
• The Diabetes and Respiratory Store Doing business as

Tax ID family

Diabetes Store Incorporated4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Diabetes Store Incorporated

  dba Diabetes Store, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Memphis, TN
  • NPI 1972529451
  NPD tax ID
• Diabetes Store, Incorporated

  dba Diabetes and Respiratory Store

  • Mail Order Pharmacy
  • Memphis, TN
  • NPI 1285191478
  NPD tax ID
• Diabetes Store, Incorporated

  dba Diabetes Store, Inc.

  • Prosthetic/Orthotic Supplier
  • Memphis, TN
  • NPI 1740875400
  NPD tax ID

Locations

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1467508598",
    "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": "1760 MORIAH WOODS BLVD",
            "address_2": "SUITE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381177128",
            "telephone_number": "901-312-3150",
            "fax_number": "800-208-0683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES STORE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "0000004074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4437643",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes and Respiratory Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Diabetes and Respiratory Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Diabetes and Respiratory Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diabetes Store, Incorporated (Diabetes and Respiratory Store)
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• Pharmacy in Memphis, TN
• Providers in Memphis, TN by specialty
• Pharmacy in Tennessee

• 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.