MEDICARE: LAMOOR BEAUTY SUPPLY

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

General Provider Information

NPI Number	:	1619515541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAMOOR BEAUTY SUPPLY

Provider Business Mailing Address
First Line	:	PO BOX 11322
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73136-0322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 N MARTIN LUTHER KING AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-2404
Country	:	US
Telephone Number	:	405-427-6571
Fax Number	:	405-427-5680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALWIN MOORE
Credential	:
Telephone Number	:	405-427-6571

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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Directions to “LAMOOR BEAUTY SUPPLY ” Practice Location

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