Provider Demographics
NPI:1700511318
Name:LACTATION DEPOT LLC
Entity Type:Organization
Organization Name:LACTATION DEPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZERSZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-315-3196
Mailing Address - Street 1:10275 PEOTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10775 MCKINLEY HWY STE C
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-9164
Practice Address - Country:US
Practice Address - Phone:574-315-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty