MEDICARE: SOLOVELEEHAIR RX COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1811510100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOVELEEHAIR RX COMPANY

Provider Business Mailing Address
First Line	:	701 E CATHEDRAL RD STE 45
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	267-992-5730
Fax Number	:	814-250-3502

Provider Business Practice Location Address
First Line	:	701 E CATHEDRAL RD STE 45
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	267-992-5730
Fax Number	:	814-250-3502

Authorized Official
Title or Position	:	OWNER
Name	:	LISA MANN
Credential	:
Telephone Number	:	267-992-5730

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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Directions to “SOLOVELEEHAIR RX COMPANY ” Practice Location

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