Provider Demographics
NPI:1043907413
Name:THE HAIR CLINIC RX, LLC
Entity type:Organization
Organization Name:THE HAIR CLINIC RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-281-9603
Mailing Address - Street 1:235 W MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4868
Mailing Address - Country:US
Mailing Address - Phone:667-281-9603
Mailing Address - Fax:
Practice Address - Street 1:235 W MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4868
Practice Address - Country:US
Practice Address - Phone:667-281-9603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty