Provider Demographics
NPI:1497345565
Name:MERAKI BEAUTY SUPPLY
Entity Type:Organization
Organization Name:MERAKI BEAUTY SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-735-1138
Mailing Address - Street 1:14660 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4521
Mailing Address - Country:US
Mailing Address - Phone:612-735-1138
Mailing Address - Fax:
Practice Address - Street 1:14660 13TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4521
Practice Address - Country:US
Practice Address - Phone:612-735-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies