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General NPI Number Information
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NPI Number | 1366625790
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Entity Type | Organization
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Legal Business Name | HAIR SPECIALTY SUPPLY
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 07/04/2008
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Provider Practice Location Address
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Address Line | 5707 CIBOLO CANYON BLVD 1617
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2773
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Country | US
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Telephone | 210-367-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 5707 CIBOLO CANYON BLVD 1617
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2773
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Country | US
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Telephone | 210-367-3800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS LELA Z HAMILTON
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Credential |
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Telephone | 210-367-3800
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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 | 1011437
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License Number State | TX
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