Active Living Store Inc.
NPI #1871633073 in Summerfield, Florida
Provider Information
- NPI Number
- 1871633073
- Entity Type
- Organization
- Organization Name
- Active Living Store Inc.
- Primary Specialty
- Durable Medical Equipment & Medical Supplies
- Enumeration Date
- Feb 7, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 17860 SE 109TH AVE
- Address 2
- #630
- City
- Summerfield
- State
- Florida
- ZIP Code
- 34491-8911
- Phone
- (352) 307-3511
Authorized Official
- Name
- MR. PAGE R. WHITTLE
- Title
- VICE PRESIDENT
- Phone
- (352) 307-3511
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
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