Healthcare Provider Details

I. General information

NPI: 1437771110
Provider Name (Legal Business Name): THE GLAM SHOP BY ANITRA SHAREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 09/28/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN AVE
GASTONIA NC
28052
US

IV. Provider business mailing address

3306 TABLE ROCK DR
GASTONIA NC
28052-5437
US

V. Phone/Fax

Practice location:
  • Phone: 704-923-1469
  • Fax:
Mailing address:
  • Phone: 704-923-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANITRA NASH PHIFER
Title or Position: OWNER
Credential: HAIR LOSS SPECIALIST
Phone: 704-923-1469