Provider Demographics
NPI:1902286396
Name:PINK MOON WIGS AND HAIR COLLECTION
Entity Type:Organization
Organization Name:PINK MOON WIGS AND HAIR COLLECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MCCORKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-916-9737
Mailing Address - Street 1:201 SHANNON OAKS CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5570
Mailing Address - Country:US
Mailing Address - Phone:919-753-3469
Mailing Address - Fax:
Practice Address - Street 1:201 SHANNON OAKS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5570
Practice Address - Country:US
Practice Address - Phone:919-916-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies