| NPI | 1104413418 |
|---|---|
| Doing Business As | MYSTIQE RX |
| Entity Type | Organization |
| Authorized Contact | CASSAUNDRA CHANELLE COLLINS Manger 832-512-9560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2020-12-22 |