Provider Demographics
NPI:1114152568
Name:PINK RIBBON BOUTIQUE INC
Entity Type:Organization
Organization Name:PINK RIBBON BOUTIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CMF
Authorized Official - Prefix:
Authorized Official - First Name:BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:479-242-9277
Mailing Address - Street 1:601 SOUTH 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901
Mailing Address - Country:US
Mailing Address - Phone:479-242-9277
Mailing Address - Fax:479-242-8251
Practice Address - Street 1:601 SOUTH 21ST STREET
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901
Practice Address - Country:US
Practice Address - Phone:479-242-9277
Practice Address - Fax:479-242-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6254060001Medicare NSC