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General NPI Number Information
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NPI Number | 1700544186
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Entity Type | Organization
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Legal Business Name | WOWDAMNFOXY HAIR LLC
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/05/2021
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Provider Practice Location Address
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Address Line | 4600 JONESTOWN RD # 74
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City | HARRISBURG
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State | PA
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Zip | 17109-6214
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Country | US
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Telephone | 717-210-8970
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Fax | 844-501-0120
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Provider Business Mailing Address
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Address Line | 4600 JONESTOWN RD # 74
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City | HARRISBURG
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State | PA
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Zip | 17109-6214
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Country | US
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Telephone | 717-210-8970
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Fax | 844-501-0120
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Authorized Official
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Title or Position | OWNER
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Name | MS. LATORIA BYAS
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Credential |
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Telephone | 717-210-8970
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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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