Active NPI
MK Glam RX
- Prosthetic/Orthotic Supplier
- Philadelphia, PA
National Provider Identifier
1477228906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- MK GLAM RX
- Practice address
- 2290 W Oregon Ave # 1026
Philadelphia, PA 19145-4197 - Phone
- (267) 399-0081
- NPI assigned
- Aug 16, 2021
- Last updated
- Aug 16, 2021
- Organization subpart
- Yes
- Parent organization
- MK GLAM LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Maeyonni Westbrook
- Title
- Owner
- Phone
- (215) 609-2907
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | NU | Primary |
Addresses
Primary practice location
2290 W Oregon Ave # 1026
Philadelphia, PA 19145-4197
Mailing address
2290 W Oregon Ave # 1026
Philadelphia, PA 19145-4197
Phone (267) 399-0081
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 2159149071 | Other |
National Provider Directory
National Provider Directory- Part of
- MK Glam RX
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Prosthetist
- Philadelphia, PA
- NPI 1760112189
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629072000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629072000000",
"number": "1477228906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2290 W OREGON AVE # 1026",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191454197",
"telephone_number": "267-399-0081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2290 W OREGON AVE # 1026",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191454197",
"telephone_number": "267-399-0081"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MK GLAM RX",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MK GLAM LLC",
"enumeration_date": "2021-08-16",
"last_updated": "2021-08-16",
"certification_date": "2021-08-16",
"status": "A",
"authorized_official_last_name": "WESTBROOK",
"authorized_official_first_name": "MAEYONNI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "215-609-2907"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "2159149071",
"affiliation": "N",
"endpointDescription": "FAX",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FAX",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2290 W Oregon Ave # 1026",
"city": "Philadelphia",
"state": "PA",
"country_code": "US",
"postal_code": "191454197",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.