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General NPI Number Information
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NPI Number | 1669780482
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Entity Type | Organization
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Legal Business Name | THE PINK DOOR BOUTIQUE LLC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1623 VIEW WOODS DR
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City | KIRKWOOD
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State | MO
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Zip | 63122-3522
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Country | US
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Telephone | 314-822-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 VIEW WOODS DR
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City | KIRKWOOD
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State | MO
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Zip | 63122-3522
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Country | US
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Telephone | 314-822-8255
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEIRDRE SHEAD
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Credential |
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Telephone | 314-600-1005
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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 | LC1085182
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License Number State | MO
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