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General NPI Number Information
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NPI Number | 1700420742
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Entity Type | Organization
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Legal Business Name | INKCREDIBLE TATTOO FACTORY
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Dates
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Enumeration Date | 11/02/2019
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Last Update Date | 11/02/2019
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Provider Practice Location Address
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Address Line | 40 S MARKET ST
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2307
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Country | US
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Telephone | 717-205-7187
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Fax |
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Provider Business Mailing Address
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Address Line | 125 JOSEPH RD
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City | LANCASTER
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State | PA
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Zip | 17603-5903
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Country | US
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Telephone | 717-205-7187
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Fax |
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Authorized Official
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Title or Position | MEDICAL TATTOO TECH./OWNER
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Name | MRS. BRIDGET L GRANT
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Credential |
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Telephone | 717-205-7187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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