Healthcare Provider Details

I. General information

NPI: 1902091051
Provider Name (Legal Business Name): PINK RIBBON BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 FORREST AVE STE 100
DOVER DE
19904-3382
US

IV. Provider business mailing address

1030 FORREST AVE STE 100
DOVER DE
19904-3382
US

V. Phone/Fax

Practice location:
  • Phone: 302-223-6889
  • Fax: 302-223-6890
Mailing address:
  • Phone: 302-223-6889
  • Fax: 302-223-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2007603877
License Number StateDE

VIII. Authorized Official

Name: MRS. THERESA C HADLEY
Title or Position: OWNER/MEMBER
Credential:
Phone: 302-223-6889