=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710122205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSANS UNIFORM SHOP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2008
-----------------------------------------------------
Last Update Date | 06/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 MURPHY RD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-654-7507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MURPHY ROAD PLAZA
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-654-7507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | KAROLIN LIPMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-654-7507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1989025884
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------