Provider Demographics
NPI:1750144788
Name:EVOLVING BEAUTY MAKEOVER STUDIO LLC
Entity type:Organization
Organization Name:EVOLVING BEAUTY MAKEOVER STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TOCCARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-832-9969
Mailing Address - Street 1:10207 S DOLFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3607
Mailing Address - Country:US
Mailing Address - Phone:443-832-9969
Mailing Address - Fax:
Practice Address - Street 1:10207 S DOLFIELD RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3607
Practice Address - Country:US
Practice Address - Phone:443-832-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies