Organization
LE BUSTIERE BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE JACEK (MANAGER)
(202) 745-8080
Entity
Organization
Contact information
Practice address
1744 COLUMBIA RD NW, #2, WASHINGTON, DC 20009-2881
(202) 745-8080
(202) 745-8081
Mailing address
1744 COLUMBIA RD NW, #2, WASHINGTON, DC 20009-2881
(202) 745-8080
(202) 745-8081
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
400314900285
DC
335E00000X
Prosthetic/Orthotic Supplier
400314900285
DC
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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