MEDICARE: STUDIO GLAMOUR HAIR SALON & RESTORATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1639681752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUDIO GLAMOUR HAIR SALON & RESTORATION CENTER

Provider Business Mailing Address
First Line	:	2344 EBENEZER RD STE C
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-8266
Country	:	US
Telephone Number	:	803-493-9895
Fax Number	:

Provider Business Practice Location Address
First Line	:	2344 EBENEZER RD STE C
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-8266
Country	:	US
Telephone Number	:	803-493-9895
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PRACTITIONER
Name	:	KARI EVANS
Credential	:
Telephone Number	:	803-415-4947

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	01/06/2021

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