Individual
LAKEYSHA DEMAR MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5109 ROCK BEAUTY CT, WALDORF, MD 20603-4789
(240) 346-8178
(240) 607-7057
Mailing address
5109 ROCK BEAUTY CT, WALDORF, MD 20603-4789
(240) 346-8178
(240) 607-7057
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MD
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
HAIR LOSS PRACTITIONER
MD
Enumeration date
07/20/2021
Last updated
07/20/2021
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