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General NPI Number Information
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NPI Number | 1558814426
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Entity Type | Organization
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Legal Business Name | HAIR IS IN SALON, SPA & BOUTIQUE LLC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 4408 W OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1819
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Country | US
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Telephone | 954-486-2472
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Fax |
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Provider Business Mailing Address
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Address Line | 4408 W OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1819
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Country | US
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Telephone | 954-486-2472
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Fax |
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Authorized Official
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Title or Position | TRICHOLOGIST/OWNER
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Name | MRS. PEGGY NISBETT RIGG
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Credential | BA, NTTI
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Telephone | 954-486-2472
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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 | CL0148954
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | CL0148954
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License Number State | FL
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