=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033050547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL GLOW- MEN'S AND WOMEN'S HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2026
-----------------------------------------------------
Last Update Date | 04/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1494 LAKE MURRAY BLVD STE A
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-8697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-883-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1494 LAKE MURRAY BLVD STE A
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-8697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-883-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CANDACE DANBURY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 803-883-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------