# BOOB SHOP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225650666
- **Authorized official:** BROOKE STRACHAN (PRESIDENT)
- **Authorized official phone:** (757) 706-5571

## Contact information

- **Practice address:** 4900 BROADWAY ST STE 700, SAN ANTONIO, TX 78209-5739
- **Practice address phone:** (757) 706-5571
- **Mailing address:** 250 TREELINE PARK APT 302, SAN ANTONIO, TX 78209-7401
- **Mailing address phone:** (757) 706-5571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 05/07/2020
- **Last updated:** 07/24/2020