Provider Demographics
NPI:1447895198
Name:EVEXIA DIABETES SUPPLY, LLC
Entity type:Organization
Organization Name:EVEXIA DIABETES SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-487-0310
Mailing Address - Street 1:8 THE GRN # 8151
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3618
Mailing Address - Country:US
Mailing Address - Phone:302-487-0310
Mailing Address - Fax:302-526-0002
Practice Address - Street 1:8 THE GRN # 8151
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:302-487-0310
Practice Address - Fax:302-526-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies