Provider Demographics
NPI:1336927565
Name:SIMPLY DIABETIC SUPPLY LLC
Entity Type:Organization
Organization Name:SIMPLY DIABETIC SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-365-4885
Mailing Address - Street 1:19847 CENTURY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19847 CENTURY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7204
Practice Address - Country:US
Practice Address - Phone:443-365-4885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies