# CONNIES MASTECTOMY BOUTIQUE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982739603
- **Authorized official:** MRS. CONSTANCE B CRIDER (PRESIDENT, TREASURER, DIRECTOR)
- **Authorized official phone:** (352) 795-5223

## Contact information

- **Practice address:** 430 NE 3RD STREET, SUITE 1, CRYSTAL RIVER, FL 34429-4244
- **Practice address phone:** (352) 795-5223
- **Practice address fax:** (352) 795-6390
- **Mailing address:** 0430 NE 3RD ST, SUITE 1, CRYSTAL RIVER, FL 34429-4244
- **Mailing address phone:** (352) 795-5223
- **Mailing address fax:** (352) 795-6390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | FL | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 11/17/2008