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General NPI Number Information
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NPI Number | 1598431991
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Entity Type | Organization
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Legal Business Name | THE WIG DISPENSARY
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 1070 MONTGOMERY RD STE 2351
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7420
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Country | US
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Telephone | 407-619-6827
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Fax | 407-906-9364
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Provider Business Mailing Address
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Address Line | 1070 MONTGOMERY RD # 2351
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7420
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Country | US
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Telephone | 407-619-6827
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Fax | 407-906-9364
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Authorized Official
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Title or Position | CEO
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Name | JAZMIN BADIE
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Credential |
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Telephone | 407-335-2243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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