Provider Demographics
NPI:1366625790
Name:HAIR SPECIALTY SUPPLY
Entity Type:Organization
Organization Name:HAIR SPECIALTY SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LELA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-367-3800
Mailing Address - Street 1:5707 CIBOLO CANYON BLVD
Mailing Address - Street 2:1617
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2773
Mailing Address - Country:US
Mailing Address - Phone:210-367-3800
Mailing Address - Fax:
Practice Address - Street 1:5707 CIBOLO CANYON BLVD
Practice Address - Street 2:1617
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-2773
Practice Address - Country:US
Practice Address - Phone:210-367-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011437335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier