Provider Demographics
NPI:1972837995
Name:UNIQUE BOUTIQUE INC
Entity type:Organization
Organization Name:UNIQUE BOUTIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
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:704-377-4356
Mailing Address - Street 1:4830 MONROE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7856
Mailing Address - Country:US
Mailing Address - Phone:704-377-4356
Mailing Address - Fax:704-377-9361
Practice Address - Street 1:4830 MONROE RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7856
Practice Address - Country:US
Practice Address - Phone:704-377-4356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIQUE BOUTIQUE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-23
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006051877332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies