Organization
HAIR ICON PROTHISIS SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIREE JENNIFER MCCLENDON (OWNER)
(757) 292-1364
Entity
Organization
Contact information
Practice address
6422 ABERDEEN PL, SUFFOLK, VA 23435-3039
(757) 292-1364
Mailing address
6422 ABERDEEN PL, SUFFOLK, VA 23435-3039
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
VA
Other
Enumeration date
06/04/2015
Last updated
06/04/2015
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