Provider Demographics
NPI:1043440894
Name:PRETTY IN PINK BOUTIQUE LLC
Entity Type:Organization
Organization Name:PRETTY IN PINK BOUTIQUE LLC
Other - Org Name:PRETTY IN PINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:H
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-485-4774
Mailing Address - Street 1:111 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-1023
Mailing Address - Country:US
Mailing Address - Phone:706-485-4774
Mailing Address - Fax:
Practice Address - Street 1:111 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-1023
Practice Address - Country:US
Practice Address - Phone:706-485-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier