MEDICARE: THE BEAUTY PLUG DISTRIBUTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1013861715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BEAUTY PLUG DISTRIBUTION LLC

Provider Business Mailing Address
First Line	:	30 NORTH GOULD STREET
Second Line	:	#61572
City	:	SHERIDAN
State	:	WY
Zip	:	82801
Country	:	US
Telephone Number	:	813-702-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	36124 MARKREE CASTLE AVE
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-5212
Country	:	US
Telephone Number	:	813-702-8453
Fax Number	:	813-702-8453

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHIVONNA HALL
Credential	:
Telephone Number	:	813-702-8453

Provider Enumeration Date	:	02/21/2026
Last Update Date	:	02/21/2026

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