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General NPI Number Information
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NPI Number | 1528894391
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Entity Type | Organization
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Legal Business Name | I.C. BEAUTY LLC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 8030 W BROAD ST STE 117
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City | RICHMOND
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State | VA
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Zip | 23294-4223
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Country | US
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Telephone | 804-397-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 3615 CHAMBERLAYNE AVE APT 8
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City | RICHMOND
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State | VA
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Zip | 23227-4538
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Country | US
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Telephone | 804-397-3340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IISHA SILVER
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Credential |
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Telephone | 804-397-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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