Organization
A NEW YOU PINK BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY POOLE (OWNER)
(813) 661-7465
Entity
Organization
Contact information
Practice address
106 W ROBERTSON ST, BRANDON, FL 33511-5112
(813) 661-7465
(813) 661-7465
Mailing address
106 W ROBERTSON ST, BRANDON, FL 33511-5112
(813) 661-7465
(813) 661-7465
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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