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General NPI Number Information
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NPI Number | 1477864924
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Entity Type | Organization
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Legal Business Name | E-GLAM INC
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 1412 W SUSQUEHANNA AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19121-1684
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Country | US
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Telephone | 215-763-1405
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Fax | 215-232-1878
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Provider Business Mailing Address
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Address Line | 1412 WEST SUSQUEHANNA AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19122
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Country | US
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Telephone | 215-763-1405
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Fax | 215-232-1878
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. INYANG INYANG
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Credential | PHARM.D
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Telephone | 215-763-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP482026
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License Number State | PA
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