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General NPI Number Information
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NPI Number | 1679978142
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Entity Type | Organization
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Legal Business Name | PINK PRATIQUE
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 731 MAIN ST
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City | MINDEN
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State | LA
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Zip | 71055-3328
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Country | US
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Telephone | 318-564-8746
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Fax | 318-639-5096
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Provider Business Mailing Address
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Address Line | 731 MAIN ST
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City | MINDEN
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State | LA
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Zip | 71055-3328
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Country | US
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Telephone | 318-564-8746
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Fax | 318-639-5096
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH A HADNOT COOKSEY
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Credential |
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Telephone | 318-564-8746
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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 | LA
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