Organization
A WIG BOUTIQUE ETC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BLAKENEY (OWNER/OPERATOR)
(850) 476-1916
Entity
Organization
Contact information
Practice address
6707 PLANTATION RD, SUITE C3, PENSACOLA, FL 32504-6214
(850) 476-1916
(850) 476-1916
Mailing address
6707 PLANTATION RD, SUITE C3, PENSACOLA, FL 32504-6214
(850) 476-1916
(850) 476-1916
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
660943
FL
Other
Enumeration date
01/19/2010
Last updated
01/19/2010
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