Healthcare Provider Details

I. General information

NPI: 1801364575
Provider Name (Legal Business Name): PHARMA HAIR UNIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LAKE UNDERHILL RD
ORLANDO FL
32828-4508
US

IV. Provider business mailing address

12301 LAKE UNDERHILL RD STE 126 STUDIO 21
ORLANDO FL
32828
US

V. Phone/Fax

Practice location:
  • Phone: 407-758-8298
  • Fax:
Mailing address:
  • Phone: 407-595-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: CANDACE WONSEY
Title or Position: MANAGER
Credential:
Phone: 407-595-8065