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General NPI Number Information
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NPI Number | 1871817916
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Entity Type | Organization
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Legal Business Name | FASHION WIG SHOP & GIFTS LLC
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 540 BULTMAN DRIVE SUITE 3
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City | SUMTER
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State | SC
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Zip | 29150-2592
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Country | US
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Telephone | 803-774-0139
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Fax | 803-774-0139
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Provider Business Mailing Address
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Address Line | 540 BULTMAN DRIVE SUITE 3
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City | SUMTER
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State | SC
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Zip | 29150-2592
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Country | US
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Telephone | 803-774-0139
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Fax | 803-774-0139
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Authorized Official
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Title or Position | OWNER/MANGER
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Name | MRS. LYNNETTE M MCELVEEN
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Credential |
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Telephone | 803-774-0139
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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 | 20537
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License Number State | SC
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