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Organization
PURE GOLD LUXZ HAIR BEAUTY LUXURY
Active
Organization
PURE GOLD LUXZ HAIR BEAUTY LUXURY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FATIA RUSSELL CERTIFIED HAIR LOSS (OWNER)
(201) 892-2678
Entity
Organization
Contact information
Practice address
508 OWEN DR, FAYETTEVILLE, NC 28304-3417
(910) 479-6214
Mailing address
6245 LAKEHAVEN DR, FAYETTEVILLE, NC 28304-0610
(201) 892-2678
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356843379
—
NC
Enumeration date
04/30/2019
Last updated
08/31/2019
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