Organization
BARBARA GRAVES INTIMATE FASHIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRINA BRICKEY (STORE MANAGER)
(501) 227-5537
Entity
Organization
Contact information
Practice address
10301 N RODNEY PARHAM RD, LITTLE ROCK, AR 72227-4832
(501) 227-5537
(501) 227-0655
Mailing address
10301 N RODNEY PARHAM RD, LITTLE ROCK, AR 72227-4832
(501) 227-5537
(501) 227-0655
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
02063560001
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47917
PROVIDER NUMBER
AR
Enumeration date
08/10/2005
Last updated
08/22/2020
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