Healthcare Provider Details

I. General information

NPI: 1538658950
Provider Name (Legal Business Name): THE PINK ALTERNATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HARTFORD HWY STE 1
DOTHAN AL
36305-4906
US

IV. Provider business mailing address

3000 HARTFORD HWY STE 1
DOTHAN AL
36305-4906
US

V. Phone/Fax

Practice location:
  • Phone: 334-446-3337
  • Fax: 334-446-3698
Mailing address:
  • Phone: 334-446-3337
  • Fax: 334-446-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number368
License Number StateAL

VIII. Authorized Official

Name: MS. DENISE HOLTON NEWBY
Title or Position: CERTIFIED FITTER MASTECTOMY
Credential: CFM
Phone: 334-446-3337