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General NPI Number Information
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NPI Number | 1407451362
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Entity Type | Organization
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Legal Business Name | HAIR EMPIRE BEAUTY SUPPLY
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 1236 W BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-6568
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Country | US
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Telephone | 630-394-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 1236 W BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-6568
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Country | US
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Telephone | 630-394-1992
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. ABENA OWUSU-ANSAH
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Credential | PHARMD
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Telephone | 331-250-3527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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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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