Provider Demographics
NPI:1457832354
Name:CELEBRITY STYLES INC.
Entity Type:Organization
Organization Name:CELEBRITY STYLES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-779-2054
Mailing Address - Street 1:2 AUGUSTA CT APT 203
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4617
Mailing Address - Country:US
Mailing Address - Phone:501-779-2054
Mailing Address - Fax:
Practice Address - Street 1:7 SHACKLEFORD PLZ
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1826
Practice Address - Country:US
Practice Address - Phone:501-779-2054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier