=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083241822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOSMO BEAUTY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2020
-----------------------------------------------------
Last Update Date | 03/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3275 NE 3RD TER UNIT 1006
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-4554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-204-2186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3275 NE 3RD TER UNIT 1006
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-4554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-204-2186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. KAMISHIA K BRACKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 754-204-2186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------