Healthcare Provider Details

I. General information

NPI: 1013284629
Provider Name (Legal Business Name): GLENDALE GELUZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 SCRIPPS LAKE DR STE 108
SAN DIEGO CA
92131-1080
US

IV. Provider business mailing address

10225 WESTONHILL DR
SAN DIEGO CA
92126-3711
US

V. Phone/Fax

Practice location:
  • Phone: 858-564-2000
  • Fax:
Mailing address:
  • Phone: 415-948-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: