Provider Demographics
NPI:1477864924
Name:E-GLAM INC
Entity Type:Organization
Organization Name:E-GLAM INC
Other - Org Name:E-GLAM PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:INYANG
Authorized Official - Middle Name:
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:215-763-1405
Mailing Address - Street 1:1412 WEST SUSQUEHANNA AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122
Mailing Address - Country:US
Mailing Address - Phone:215-763-1405
Mailing Address - Fax:215-232-1878
Practice Address - Street 1:1412 W SUSQUEHANNA AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-1684
Practice Address - Country:US
Practice Address - Phone:215-763-1405
Practice Address - Fax:215-232-1878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E-GLAM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482026333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy