Provider Demographics
NPI:1427395318
Name:ELEGANT BEAUTY SUPPLIES # 11 INC
Entity Type:Organization
Organization Name:ELEGANT BEAUTY SUPPLIES # 11 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BASHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-202-1224
Mailing Address - Street 1:1209 S 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5631
Mailing Address - Country:US
Mailing Address - Phone:954-921-9129
Mailing Address - Fax:
Practice Address - Street 1:2099 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2757
Practice Address - Country:US
Practice Address - Phone:954-921-9129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier