Organization
HAIRFANATIC BOUTIQUE LLC
Active
Organization
HAIRFANATIC BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARANDA BROWN DAVIS CERTIFIED HAIR LOSS (HAIR LOSS SPECIALIST)
(803) 730-0231
Entity
Organization
Contact information
Practice address
2757 LAUREL ST, SUITE 3, COLUMBIA, SC 29204-2037
(803) 730-0231
Mailing address
2757 LAUREL ST, SUITE 3, COLUMBIA, SC 29204-2037
(803) 730-0231
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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