Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Infusion Therapy |
261QI0500X | |||
Clinic/Center |
261Q00000X |
| NPI # | 1174226146 |
| LBN Legal business name | REVIVE BEAUTY & DRIP LOUNGE, PLLC |
| Authorized official | CHRYSTAL GAMMON - (OWNER/OPERATOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 03/27/2023 |
| Last updated | 04/18/2023 - About 3 years ago |
| Identifiers | n/a |
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