Healthcare Provider Details

I. General information

NPI: 1700639432
Provider Name (Legal Business Name): HEALTH GLOW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25381 ALICIA PKWY STE U
LAGUNA HILLS CA
92653-4983
US

IV. Provider business mailing address

25381 ALICIA PKWY STE U
LAGUNA HILLS CA
92653-4983
US

V. Phone/Fax

Practice location:
  • Phone: 949-800-9555
  • Fax: 949-346-9150
Mailing address:
  • Phone: 949-800-9555
  • Fax: 949-346-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROYA AGAHI
Title or Position: CEO
Credential:
Phone: 949-800-9555