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NPI Code Detail

MEDICARE: THE WIG DISPENSARY

MEDICARE: THE WIG DISPENSARY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1598431991
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE WIG DISPENSARY
Provider Business Mailing Address
First Line : 1070 MONTGOMERY RD # 2351
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-7420
Country : US
Telephone Number : 407-619-6827
Fax Number : 407-906-9364
Provider Business Practice Location Address
First Line : 1070 MONTGOMERY RD
Second Line : STE 2351
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-7420
Country : US
Telephone Number : 407-619-6827
Fax Number : 407-906-9364
Authorized Official
Title or Position : CEO
Name : JAZMIN BADIE
Credential :
Telephone Number : 407-335-2243
Provider Enumeration Date : 08/17/2021
Last Update Date : 08/17/2021

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Directions to “THE WIG DISPENSARY ” Practice Location

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