Provider Demographics
NPI:1396764379
Name:NATIONALDIABETICPHARMACIES
Entity type:Organization
Organization Name:NATIONALDIABETICPHARMACIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-777-0000
Mailing Address - Street 1:2157 APPERSON DR
Mailing Address - Street 2:NATIONAL DIABETIC PHARMACIES
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7235
Mailing Address - Country:US
Mailing Address - Phone:540-777-0000
Mailing Address - Fax:
Practice Address - Street 1:2157 APPERSON DR
Practice Address - Street 2:NATIONAL DIABETIC PHARMACIES
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7235
Practice Address - Country:US
Practice Address - Phone:540-777-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization