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General NPI Number Information
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NPI Number | 1386323442
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Entity Type | Organization
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Legal Business Name | GLAMOROUS BEAUTIQUE RX
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 4735 SHARON RD # 120
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City | CHARLOTTE
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State | NC
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Zip | 28210-3327
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Country | US
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Telephone | 770-568-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 W HWY SUITE 160 105 #352
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City | FORT MILL
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State | SC
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Zip | 29708
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Country | US
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Telephone | 770-568-7510
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARONDA DAVIS
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Credential |
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Telephone | 770-568-7510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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