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General NPI Number Information
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NPI Number | 1447431879
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Entity Type | Organization
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Legal Business Name | THE BRA LADY BOUTIQUE, INC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1085 PINEY FOREST ROAD
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City | DANVILLE
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State | VA
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Zip | 24540-1507
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Country | US
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Telephone | 434-793-5239
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Fax | 434-793-5240
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Provider Business Mailing Address
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Address Line | 1085 PINEY FOREST ROAD
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City | DANVILLE
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State | VA
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Zip | 24540-1507
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Country | US
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Telephone | 434-793-5239
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Fax | 434-793-5240
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN H LUMPKIN
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Credential | CERTIFIED MASTECTOMY
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Telephone | 434-793-5239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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