Provider Demographics
NPI:1225380454
Name:UNIQUE BEAUTY & HAIR SUPPLY LLC
Entity Type:Organization
Organization Name:UNIQUE BEAUTY & HAIR SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVENELL
Authorized Official - Middle Name:LETIONER
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-343-0165
Mailing Address - Street 1:115 N 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1600
Mailing Address - Country:US
Mailing Address - Phone:218-343-0165
Mailing Address - Fax:
Practice Address - Street 1:115 N 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1600
Practice Address - Country:US
Practice Address - Phone:218-343-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies