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General NPI Number Information
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NPI Number | 1104596857
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Entity Type | Organization
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Legal Business Name | TRICHO RX
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 6834 CANTRELL RD STE 1454
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4135
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Country | US
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Telephone | 501-575-0759
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Fax | 501-663-6646
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Provider Business Mailing Address
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Address Line | 6834 CANTRELL RD STE 1454
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4135
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Country | US
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Telephone | 501-575-0759
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Fax |
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Authorized Official
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Title or Position | PROSTHETIC ORTHOTIC PROVIDER
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Name | DWYKEIA SHANTWANA PARKER
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Credential |
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Telephone | 501-575-0759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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