MEDICARE: GLENN LAKES PHARMACY, INC.

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	183500000X	Pharmacist	20540	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326050782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENN LAKES PHARMACY, INC.

Provider Business Mailing Address
First Line	:	3640 GLENN LAKES LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4064
Country	:	US
Telephone Number	:	281-261-8278
Fax Number	:	281-499-5198

Provider Business Practice Location Address
First Line	:	3640 GLENN LAKES LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4064
Country	:	US
Telephone Number	:	281-261-8278
Fax Number	:	281-499-5198

Authorized Official
Title or Position	:	CLINICAL PHARMACY MANAGER
Name	:	MRS. MONA RACHEL FINLEY
Credential	:	R.PH.
Telephone Number	:	281-261-8278

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	12/22/2010

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