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General NPI Number Information
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NPI Number | 1114098803
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Entity Type | Organization
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Legal Business Name | MART BEAUTY SUPPLY
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3031 PETERS CREEK RD NW STE A
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City | ROANOKE
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State | VA
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Zip | 24019-2768
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Country | US
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Telephone | 540-562-2728
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Fax | 540-562-2764
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Provider Business Mailing Address
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Address Line | 3031 PETERS CREEK RD NW STE A
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City | ROANOKE
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State | VA
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Zip | 24019-2768
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Country | US
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Telephone | 540-562-2728
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Fax | 540-562-2764
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HILDA J. PATTERSON
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Credential |
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Telephone | 540-562-2728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 091855
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License Number State | VA
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