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General NPI Number Information
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NPI Number | 1285135848
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Entity Type | Organization
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Legal Business Name | CHE SALON
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 8416 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-2816
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Country | US
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Telephone | 314-395-1080
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Fax |
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Provider Business Mailing Address
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Address Line | 8416 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63132-2816
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Country | US
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Telephone | 314-395-1080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA MICHELLE WILLIAMS
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Credential | COSMETOLOGIST
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Telephone | 314-395-1080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 103943
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License Number State | MO
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