Provider Demographics
NPI:1972529451
Name:DIABETES STORE INCORPORATED
Entity type:Organization
Organization Name:DIABETES STORE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOSHIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SERIZAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-709-4079
Mailing Address - Street 1:1760 MORIAH WOODS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7128
Mailing Address - Country:US
Mailing Address - Phone:901-312-3150
Mailing Address - Fax:901-312-3152
Practice Address - Street 1:1760 MORIAH WOODS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7128
Practice Address - Country:US
Practice Address - Phone:901-312-3150
Practice Address - Fax:800-208-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4425570001Medicare ID - Type UnspecifiedMEDICARE NUMBER