Healthcare Provider Details

I. General information

NPI: 1881219616
Provider Name (Legal Business Name): GLAMMED STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BRISTLECONE LN
ELGIN SC
29045-9584
US

IV. Provider business mailing address

47 BRISTLECONE LN
ELGIN SC
29045-9584
US

V. Phone/Fax

Practice location:
  • Phone: 803-229-0775
  • Fax:
Mailing address:
  • Phone: 803-229-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: VASHAUN JOYE
Title or Position: OWNER
Credential:
Phone: 803-229-0775