Organization
THE SPECIAL WOMAN BOUTIQUE, INC
Active
Organization
THE SPECIAL WOMAN BOUTIQUE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLE CRAWLEY COOGLE (PRESIDENT)
(317) 876-3770
Entity
Organization
Contact information
Practice address
8770 COMMERCE PARK PL, SUITE A, INDIANAPOLIS, IN 46268-3172
(317) 876-3770
(317) 879-1900
Mailing address
8770 COMMERCE PARK PL, SUITE A, INDIANAPOLIS, IN 46268-3172
(317) 876-3770
(317) 879-1900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000175550
ANTHEM
IN
Enumeration date
03/08/2007
Last updated
08/22/2020
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