MEDICARE: HAIR KILLA 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1568107233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAIR KILLA LLC

Provider Business Mailing Address
First Line	:	5452 W BROAD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5452 W BROAD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2630
Country	:	US
Telephone Number	:	804-277-5255
Fax Number	:	804-463-2958

Authorized Official
Title or Position	:	ASSOCIATE TRICHOLOGIST
Name	:	MRS. ERIN TRAVERS
Credential	:
Telephone Number	:	804-277-5255

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	04/28/2022

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Directions to “HAIR KILLA LLC ” Practice Location

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