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General NPI Number Information
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NPI Number | 1295113033
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Entity Type | Organization
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Legal Business Name | THE HEALTHY BACK STORE
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 10300 SOUTHARD DR
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City | BELTSVILLE
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State | MD
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Zip | 20705-2107
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Country | US
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Telephone | 703-339-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 10300 SOUTHARD DR
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City | BELTSVILLE
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State | MD
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Zip | 20705-2107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MISTY WEISBROD
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Credential |
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Telephone | 240-241-7822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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