Provider Demographics
NPI:1871730051
Name:THE PINK RIBBON POST MASTECTOMY BOUTIQUE INC.
Entity type:Organization
Organization Name:THE PINK RIBBON POST MASTECTOMY BOUTIQUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VALENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-922-6790
Mailing Address - Street 1:2813 PROCTOR RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6443
Mailing Address - Country:US
Mailing Address - Phone:941-922-6790
Mailing Address - Fax:941-922-6807
Practice Address - Street 1:2813 PROCTOR RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6443
Practice Address - Country:US
Practice Address - Phone:941-922-6790
Practice Address - Fax:941-922-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier