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General NPI Number Information
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NPI Number | 1619212362
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Entity Type | Organization
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Legal Business Name | PINK MERMAID LLC
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 1313 GOLD STAR HWY
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City | GROTON
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State | CT
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Zip | 06340-2717
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Country | US
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Telephone | 860-865-0825
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Fax | 860-865-0826
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Provider Business Mailing Address
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Address Line | 1313 GOLD STAR HWY
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City | GROTON
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State | CT
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Zip | 06340-2717
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Country | US
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Telephone | 860-865-0825
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Fax | 860-865-0826
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Authorized Official
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Title or Position | MASTECTOMY FITTER
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Name | MRS. CAROL ANN RYALL
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Credential |
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Telephone | 860-865-0825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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