Provider Demographics
NPI:1972210508
Name:PEARL ROSE WELLNESS, INC.
Entity Type:Organization
Organization Name:PEARL ROSE WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-409-3425
Mailing Address - Street 1:1463 OAKFIELD DR STE 132
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-0802
Mailing Address - Country:US
Mailing Address - Phone:813-409-3425
Mailing Address - Fax:813-409-3427
Practice Address - Street 1:1463 OAKFIELD DR STE 132
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0802
Practice Address - Country:US
Practice Address - Phone:813-409-3425
Practice Address - Fax:813-409-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier