Provider Demographics
NPI:1497363436
Name:JUST LIKE YOU POST-MASTECTOMY FITTING BOUTIQUE LLC
Entity Type:Organization
Organization Name:JUST LIKE YOU POST-MASTECTOMY FITTING BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:870-273-4245
Mailing Address - Street 1:2913 KING ST STE 3
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5353
Mailing Address - Country:US
Mailing Address - Phone:870-203-0692
Mailing Address - Fax:870-206-7177
Practice Address - Street 1:2913 KING ST STE 3
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5353
Practice Address - Country:US
Practice Address - Phone:870-273-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies