Organization
PURPLE PALACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA C ALLEN HAIR LOSS SPECIALIST (OWNER)
(234) 521-9147
Entity
Organization
Contact information
Practice address
1214 MILFORD ST NE, CANTON, OH 44714-1636
(234) 521-9147
Mailing address
1214 MILFORD ST NE, CANTON, OH 44714-1636
(234) 521-9147
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
COSM.933895
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1744P32OOX
CERTIFIED HAIR LOSS SPECIALIST
OH
Enumeration date
08/19/2015
Last updated
08/19/2015
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