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Organization

VANITY LYFE HAIRTIQUE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JAMIKA MOORE (OWNER)
(337) 263-5769
Entity
Organization

Contact information

Practice address
3309 RYAN ST, LAKE CHARLES, LA 70601-8518
(337) 263-8828
Mailing address
3309 RYAN ST, LAKE CHARLES, LA 70601-8518
(337) 263-8828

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
10/23/2014
Last updated
10/23/2014
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