MEDICARE: HAIR SHE IS RX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1508550492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAIR SHE IS RX, LLC

Provider Business Mailing Address
First Line	:	1911 NE GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111
Country	:	US
Telephone Number	:	405-977-6515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 NE GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111
Country	:	US
Telephone Number	:	405-977-6515
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CRANIAL PROSTHESIS SPECIALIST
Name	:	ALONDRA J MITCHELL
Credential	:
Telephone Number	:	405-977-6515

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/08/2023

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Directions to “HAIR SHE IS RX, LLC ” Practice Location

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