Organization
PINK MERMAID LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL ANN RYALL (MASTECTOMY FITTER)
(860) 865-0825
Entity
Organization
Contact information
Practice address
1313 GOLD STAR HWY, GROTON, CT 06340-2717
(860) 865-0825
(860) 865-0826
Mailing address
1313 GOLD STAR HWY, GROTON, CT 06340-2717
(860) 865-0825
(860) 865-0826
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/06/2012
Last updated
05/16/2013
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