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General NPI Number Information
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NPI Number | 1114152568
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Entity Type | Organization
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Legal Business Name | PINK RIBBON BOUTIQUE INC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 601 SOUTH 21ST STREET
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City | FORT SMITH
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State | AR
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Zip | 72901
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Country | US
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Telephone | 479-242-9277
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Fax | 479-242-8251
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Provider Business Mailing Address
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Address Line | 601 SOUTH 21ST STREET
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City | FORT SMITH
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State | AR
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Zip | 72901
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Country | US
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Telephone | 479-242-9277
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Fax | 479-242-8251
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Authorized Official
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Title or Position | OWNER/CMF
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Name | BEV RAMSEY
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Credential | CMF
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Telephone | 479-242-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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