Healthcare Provider Details

I. General information

NPI: 1558814426
Provider Name (Legal Business Name): HAIR IS IN SALON, SPA & BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 W OAKLAND PARK BLVD
LAUDERDALE LAKES FL
33313-1819
US

IV. Provider business mailing address

4408 W OAKLAND PARK BLVD
LAUDERDALE LAKES FL
33313-1819
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-2472
  • Fax:
Mailing address:
  • Phone: 954-486-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberCL0148954
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCL0148954
License Number StateFL

VIII. Authorized Official

Name: MRS. PEGGY NISBETT RIGG
Title or Position: TRICHOLOGIST/OWNER
Credential: BA, NTTI
Phone: 954-486-2472