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General NPI Number Information
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NPI Number | 1336689504
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Entity Type | Organization
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Legal Business Name | PINKARPET HAIR BOUTIQUE L.L.C.
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 6712 OLD CANTON RD
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City | RIDGELAND
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State | MS
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Zip | 39157-1205
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Country | US
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Telephone | 601-832-0944
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Fax |
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Provider Business Mailing Address
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Address Line | 5679 BEECHWOOD DR
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City | JACKSON
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State | MS
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Zip | 39206-2708
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Country | US
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Telephone | 601-832-0944
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOROTHY N SUMMERS
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Credential | MBA
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Telephone | 601-832-0944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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