Healthcare Provider Details

I. General information

NPI: 1972420917
Provider Name (Legal Business Name): THE WIG DOCTOR RX FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 COMMERCE ST
JACKSONVILLE FL
32211-5257
US

IV. Provider business mailing address

9061 WESTERN WAY UNIT 4
JACKSONVILLE FL
32256-0380
US

V. Phone/Fax

Practice location:
  • Phone: 904-480-0189
  • Fax:
Mailing address:
  • Phone: 904-480-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDE HARRIS
Title or Position: OWNER
Credential:
Phone: 904-480-0189