MEDICARE: PINK RIBBON BOUTIQUE 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	332B00000X	Durable Medical Equipment & Medical Supplies	2007603877	DE

General Provider Information

NPI Number	:	1902091051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK RIBBON BOUTIQUE LLC

Provider Business Mailing Address
First Line	:	1030 FORREST AVE STE 100
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-3382
Country	:	US
Telephone Number	:	302-223-6889
Fax Number	:	302-223-6890

Provider Business Practice Location Address
First Line	:	1030 FORREST AVE STE 100
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-3382
Country	:	US
Telephone Number	:	302-223-6889
Fax Number	:	302-223-6890

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	MRS. THERESA C HADLEY
Credential	:
Telephone Number	:	302-223-6889

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	05/26/2026

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