Healthcare Provider Details

I. General information

NPI: 1821561069
Provider Name (Legal Business Name): GLAM2GO BEAUTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18500 LIBBY RD
MAPLE HEIGHTS OH
44137-1522
US

IV. Provider business mailing address

18500 LIBBY RD
MAPLE HEIGHTS OH
44137-1522
US

V. Phone/Fax

Practice location:
  • Phone: 216-339-3080
  • Fax:
Mailing address:
  • Phone: 216-339-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MALIKA BROWN
Title or Position: OWNER
Credential:
Phone: 216-339-3080