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General NPI Number Information
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NPI Number | 1831866987
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Entity Type | Organization
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Legal Business Name | PURE LUXE BEAUTY AND BUNDLES LLC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 569 SPRYFIELD RD
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City | JACKSON
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State | MS
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Zip | 39212-4646
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Country | US
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Telephone | 662-590-6603
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Fax |
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Provider Business Mailing Address
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Address Line | 665 S PEAR ORCHARD RD STE 106-510
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 662-590-6603
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Fax | 662-499-2309
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Authorized Official
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Title or Position | OWNER
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Name | SHAVONNA LUCKETT
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Credential |
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Telephone | 662-590-6603
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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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