Provider Demographics
NPI:1376843912
Name:PHILADELPHIA CHEMOCAP HAIR STORE
Entity Type:Organization
Organization Name:PHILADELPHIA CHEMOCAP HAIR STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:215-922-2119
Mailing Address - Street 1:766 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3137
Mailing Address - Country:US
Mailing Address - Phone:215-922-2119
Mailing Address - Fax:215-922-2245
Practice Address - Street 1:766 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3137
Practice Address - Country:US
Practice Address - Phone:215-922-2119
Practice Address - Fax:215-922-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3702178204332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site