Organization
MARCELLA'S BOUTIQUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE STEWART (MANAGER)
(814) 943-1663
Entity
Organization
Contact information
Practice address
1635 E PLEASANT VALLEY BLVD, ALTOONA, PA 16602-7305
(814) 943-1663
(814) 943-5063
Mailing address
1635 E PLEASANT VALLEY BLVD, ALTOONA, PA 16602-7305
(814) 943-1663
(814) 943-5063
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000002343
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009261500002
—
PA
01
—
200735
HIGHMARK
PA
Enumeration date
02/16/2010
Last updated
02/16/2010
Update your record
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