Provider Demographics
NPI:1396453643
Name:BU BEAUTY HAIR STUDIO
Entity type:Organization
Organization Name:BU BEAUTY HAIR STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPLIER
Authorized Official - Prefix:
Authorized Official - First Name:CASHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:SUPPLIER
Authorized Official - Phone:727-403-9941
Mailing Address - Street 1:10963 CARLTON FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12950 US 301 S STE 119
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7459
Practice Address - Country:US
Practice Address - Phone:727-403-9941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies