Provider Demographics
NPI:1164594750
Name:PINK RIBBON REFLECTIONS, LLC
Entity Type:Organization
Organization Name:PINK RIBBON REFLECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MASTECTOMY FITTER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:636-583-4181
Mailing Address - Street 1:25 LINDSEY DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2087
Mailing Address - Country:US
Mailing Address - Phone:636-583-4181
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3128
Practice Address - Country:US
Practice Address - Phone:636-239-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies