| Entity Name: | DIABETES STORE, INCORPORATED |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Active |
| Date Filed: | 26 Sep 2019 (5 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 02 Jul 2021 (4 years ago) |
| Document Number: | F19000004426 |
| FEI/EIN Number | 02-0569951 |
| Address: | 5182 W 76th St., Edina, MN, 55439, US |
| Mail Address: | 5182 W 76th St., Edina, MN, 55439, US |
| Place of Formation: | TENNESSEE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417592726 | 2019-11-11 | 2022-11-11 | 1760 MORIAH WOODS BLVD STE 2, MEMPHIS, TN, 381177128, US | 777 DELTONA BLVD STE 4, DELTONA, FL, 327257174, US | |||||||||||||||||||||||||
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| Phone | +1 901-312-3150 |
| Fax | 8002080863 |
Authorized person
| Name | CRAIG BROSSEAU |
| Role | SECRETARY |
| Phone | 9526463255 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 4425570004 |
| State | FL |
| Name | Role |
|---|---|
| NRAI SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Brosseau Craig | Secretary | 5182 W 76th St., Edina, MN, 55439 |
| Name | Role | Address |
|---|---|---|
| Brosseau Craig | Vice President | 5182 W 76th St., Edina, MN, 55439 |
| Name | Role | Address |
|---|---|---|
| Brosseau Craig | o | 5182 W 76th St., Edina, MN, 55439 |
| Name | Role | Address |
|---|---|---|
| Inoue Tadashi | Director | 5182 W 76th St., Edina, MN, 55439 |
| Name | Role | Address |
|---|---|---|
| Inoue Tadashi | President | 5182 W 76th St., Edina, MN, 55439 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-09 | 5182 W 76th St., Edina, MN 55439 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-09 | 5182 W 76th St., Edina, MN 55439 | No data |
| AMENDMENT | 2021-07-02 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-04-04 |
| Amendment | 2021-07-02 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-05-28 |
| Foreign Profit | 2019-09-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
