MEDICARE: GLENVIEW PROFESSIONAL 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	2553	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2090330	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689653040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENVIEW PROFESSIONAL PHARMACY INC

Provider Business Mailing Address
First Line	:	7640 GLENVIEW DR
Second Line	:	SUITE A
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76180-8330
Country	:	US
Telephone Number	:	817-284-1489
Fax Number	:	817-284-1042

Provider Business Practice Location Address
First Line	:	7640 GLENVIEW DR STE A
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76180-8330
Country	:	US
Telephone Number	:	817-284-1489
Fax Number	:	817-284-1042

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KEITH FREAL VAN HEISE
Credential	:	RPH
Telephone Number	:	817-284-1489

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	05/01/2019

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Directions to “GLENVIEW PROFESSIONAL PHARMACY INC ” Practice Location

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