=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376298240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAIR AS PRESCRIBED RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1576 ROOSEVELT DR
-----------------------------------------------------
City | SHARON HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19079-2439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-476-2637
-----------------------------------------------------
Fax | 267-550-5038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 MORTON AVE # 1045
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19033-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-476-2637
-----------------------------------------------------
Fax | 267-550-5038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. AESHA BROOKS
-----------------------------------------------------
Credential | COSMETOLOGIST
-----------------------------------------------------
Telephone | 267-476-2637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------