Provider Demographics
NPI:1558814426
Name:HAIR IS IN SALON, SPA & BOUTIQUE LLC
Entity Type:Organization
Organization Name:HAIR IS IN SALON, SPA & BOUTIQUE LLC
Other - Org Name:TRICHOLOGY &HAIR WELLNESS SALON
Other - Org Type:Other Name
Authorized Official - Title/Position:TRICHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:NISBETT
Authorized Official - Last Name:RIGG
Authorized Official - Suffix:
Authorized Official - Credentials:BA, NTTI
Authorized Official - Phone:954-486-2472
Mailing Address - Street 1:4408 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1819
Mailing Address - Country:US
Mailing Address - Phone:954-486-2472
Mailing Address - Fax:
Practice Address - Street 1:4408 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1819
Practice Address - Country:US
Practice Address - Phone:954-486-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL0148954332900000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No335E00000XSuppliersProsthetic/Orthotic Supplier