MEDICARE: IN THE PINK BOUTIQUE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		FL

General Provider Information

NPI Number	:	1134356835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN THE PINK BOUTIQUE, INC.

Provider Business Mailing Address
First Line	:	1835 3RD ST N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7469
Country	:	US
Telephone Number	:	904-372-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 3RD ST N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7031
Country	:	US
Telephone Number	:	904-372-0029
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ CEO
Name	:	MRS. JERI K MILLARD
Credential	:
Telephone Number	:	904-534-3266

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	05/08/2026

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