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General NPI Number Information
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NPI Number | 1457986499
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Entity Type | Organization
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Legal Business Name | LALA LASHES CHARLOTTE
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 2434 SHAD CT
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City | CHARLOTTE
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State | NC
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Zip | 28208-3307
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Country | US
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Telephone | 704-366-5274
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Fax |
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Provider Business Mailing Address
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Address Line | 841 BAXTER ST STE 114
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City | CHARLOTTE
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State | NC
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Zip | 28202-2720
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Country | US
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Telephone | 704-366-5274
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Fax |
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Authorized Official
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Title or Position | COSMETOLOGIST / CRANIAL PROTHESIS
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Name | CHARRYSE Y RANKIN
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Credential | COSMETOLOGY LICENSE
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Telephone | 704-366-5274
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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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