Provider Demographics
NPI:1437746302
Name:TARA HOUSE OF STYLEZ
Entity Type:Organization
Organization Name:TARA HOUSE OF STYLEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:MARCELL
Authorized Official - Last Name:PETTIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-858-7705
Mailing Address - Street 1:3530 E NORTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1632
Mailing Address - Country:US
Mailing Address - Phone:443-858-7705
Mailing Address - Fax:
Practice Address - Street 1:3530 E NORTHERN PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1632
Practice Address - Country:US
Practice Address - Phone:443-858-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier