Provider Demographics
NPI:1629362454
Name:DIABETES CARE CLUB LLC
Entity Type:Organization
Organization Name:DIABETES CARE CLUB LLC
Other - Org Name:RX CARE CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARSON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-771-6663
Mailing Address - Street 1:6840 CAROTHERS PKWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6390
Mailing Address - Country:US
Mailing Address - Phone:800-928-1887
Mailing Address - Fax:
Practice Address - Street 1:6840 CAROTHERS PKWY
Practice Address - Street 2:SUITE 119
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6390
Practice Address - Country:US
Practice Address - Phone:800-928-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000048623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy