Provider Demographics
NPI:1336689504
Name:PINKARPET HAIR BOUTIQUE L.L.C.
Entity Type:Organization
Organization Name:PINKARPET HAIR BOUTIQUE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-832-0944
Mailing Address - Street 1:5679 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-2708
Mailing Address - Country:US
Mailing Address - Phone:601-832-0944
Mailing Address - Fax:
Practice Address - Street 1:6712 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1205
Practice Address - Country:US
Practice Address - Phone:601-832-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment