Organization
THE BRA LADY BOUTIQUE, INC
Active
Organization
THE BRA LADY BOUTIQUE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN H LUMPKIN CERTIFIED MASTECTOMY (OWNER)
(434) 793-5239
Entity
Organization
Contact information
Practice address
1085 PINEY FOREST ROAD, DANVILLE, VA 24540-1507
(434) 793-5239
(434) 793-5240
Mailing address
1085 PINEY FOREST ROAD, DANVILLE, VA 24540-1507
(434) 793-5239
(434) 793-5240
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009190236
—
VA
01
—
217268
BC/BS OF VA
VA
Enumeration date
11/14/2007
Last updated
10/29/2015
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