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Organization

BRE'S BEAUTIQUE RX

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BREONNA GIST (OWNER)
(757) 609-0334
Entity
Organization

Contact information

Practice address
3590 TOWNE POINT RD UNIT 6543, PORTSMOUTH, VA 23703-1309
(757) 609-0334
Mailing address
112 FARO LN, PORTSMOUTH, VA 23703-5475

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Enumeration date
02/18/2021
Last updated
02/18/2021
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