Provider Demographics
NPI:1407377575
Name:BEAUTY BAR & SUPPLY LLC
Entity Type:Organization
Organization Name:BEAUTY BAR & SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANTIONETTE
Authorized Official - Last Name:MESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-210-8535
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR STE 112
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:919-210-8535
Mailing Address - Fax:
Practice Address - Street 1:7830 GOOD MIDDLING DR STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5996
Practice Address - Country:US
Practice Address - Phone:910-223-9252
Practice Address - Fax:910-223-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty