Healthcare Provider Details

I. General information

NPI: 1407377575
Provider Name (Legal Business Name): BEAUTY BAR & SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 GOOD MIDDLING DR STE A
FAYETTEVILLE NC
28304-5996
US

IV. Provider business mailing address

439 WESTWOOD SHOPPING CTR STE 112
FAYETTEVILLE NC
28314-1532
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-9252
  • Fax: 910-223-9252
Mailing address:
  • Phone: 919-210-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIE ANTIONETTE MESSICK
Title or Position: OWNER
Credential:
Phone: 919-210-8535