Provider Demographics
NPI:1790349850
Name:UNIQUE BOUTIQUE INC
Entity Type:Organization
Organization Name:UNIQUE BOUTIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUCHARSKI-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-900-9589
Mailing Address - Street 1:200 MEDICAL PARK DR STE 145
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0928
Mailing Address - Country:US
Mailing Address - Phone:980-248-1897
Mailing Address - Fax:980-248-1899
Practice Address - Street 1:200 MEDICAL PARK DR STE 145
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0928
Practice Address - Country:US
Practice Address - Phone:980-248-1897
Practice Address - Fax:980-248-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment