Provider Demographics
NPI:1669467742
Name:COLOR ME PINK BOUTIQUE, INC.
Entity Type:Organization
Organization Name:COLOR ME PINK BOUTIQUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICITE
Authorized Official - Middle Name:H
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:919-419-7375
Mailing Address - Street 1:2404 NELSON HWY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8925
Mailing Address - Country:US
Mailing Address - Phone:919-419-7375
Mailing Address - Fax:919-493-1640
Practice Address - Street 1:2404 NELSON HWY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8925
Practice Address - Country:US
Practice Address - Phone:919-419-7375
Practice Address - Fax:919-493-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046P7OtherBCBS SUPPLIER
NC5313630001Medicare NSC