Healthcare Provider Details

I. General information

NPI: 1528799731
Provider Name (Legal Business Name): PINK ESSENTIALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 E 65TH ST
INDIANAPOLIS IN
46220-1503
US

IV. Provider business mailing address

2447 E 65TH ST
INDIANAPOLIS IN
46220-1503
US

V. Phone/Fax

Practice location:
  • Phone: 463-710-3773
  • Fax:
Mailing address:
  • Phone: 463-710-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TIARA PEOPLES
Title or Position: OWNER/OPERATOR
Credential: HAIR LOSS SPECIALIST
Phone: 463-710-3773