Provider Demographics
NPI:1992288740
Name:UNIQUE BOUTIQUE INC
Entity type:Organization
Organization Name:UNIQUE BOUTIQUE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
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:704-377-4356
Mailing Address - Street 1:2155 CELANESE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1305
Mailing Address - Country:US
Mailing Address - Phone:803-329-1216
Mailing Address - Fax:803-329-1218
Practice Address - Street 1:2155 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1305
Practice Address - Country:US
Practice Address - Phone:803-329-1216
Practice Address - Fax:803-329-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid