Healthcare Provider Details

I. General information

NPI: 1003606435
Provider Name (Legal Business Name): GLOW AESTHETICS & HORMONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 HANOVER PIKE UNIT B1
MANCHESTER MD
21102-1454
US

IV. Provider business mailing address

1302 N MAIN STREET STORE 1
HAMPSTEAD MD
21074
US

V. Phone/Fax

Practice location:
  • Phone: 443-900-2042
  • Fax: 531-200-5431
Mailing address:
  • Phone: 443-900-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY MILLER
Title or Position: OWNER
Credential: NP
Phone: 443-900-2042