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General NPI Number Information
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NPI Number | 1043907413
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Entity Type | Organization
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Legal Business Name | THE HAIR CLINIC RX, LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 235 W MAIN ST STE E
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City | SALISBURY
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State | MD
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Zip | 21801-4868
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Country | US
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Telephone | 667-281-9603
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W MAIN ST STE E
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City | SALISBURY
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State | MD
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Zip | 21801-4868
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Country | US
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Telephone | 667-281-9603
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Fax |
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Authorized Official
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Title or Position | HAIR LOSS PRACTITIONER
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Name | MRS. BRANDI NICHOLE WALLACE
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Credential |
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Telephone | 667-281-9603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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