Provider Demographics
NPI:1619629334
Name:MAGIC BEAUTY RX
Entity Type:Organization
Organization Name:MAGIC BEAUTY RX
Other - Org Name:FELICIA DRUMMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROSTHETIC CRANIAL SUPPLIER
Authorized Official - Prefix:MISS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:LASHANDA
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGY LICENSE
Authorized Official - Phone:864-612-7488
Mailing Address - Street 1:102 VIRGINIA CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1458
Mailing Address - Country:US
Mailing Address - Phone:864-612-7488
Mailing Address - Fax:
Practice Address - Street 1:3237 N PLEASANTBURG DR
Practice Address - Street 2:SUITE D3
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609
Practice Address - Country:US
Practice Address - Phone:864-612-7488
Practice Address - Fax:252-203-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC250511249OtherSUPPLIER