Provider Demographics
NPI:1073932190
Name:DELMARVA WIGS AND THINGS LLC
Entity Type:Organization
Organization Name:DELMARVA WIGS AND THINGS LLC
Other - Org Name:MARKET STREET BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:410-742-0100
Mailing Address - Street 1:720 E COLLEGE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6657
Mailing Address - Country:US
Mailing Address - Phone:410-742-0100
Mailing Address - Fax:410-742-0104
Practice Address - Street 1:720 E COLLEGE AVE STE D
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6657
Practice Address - Country:US
Practice Address - Phone:410-742-0100
Practice Address - Fax:410-742-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies