Healthcare Provider Details

I. General information

NPI: 1821323759
Provider Name (Legal Business Name): GLORY GLOBAL GROUP INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5192 MARINER BLVD
SPRING HILL FL
34609-1802
US

IV. Provider business mailing address

5192 MARINER BLVD.
SPRING HILL FL
33609
US

V. Phone/Fax

Practice location:
  • Phone: 352-610-4410
  • Fax: 352-610-4411
Mailing address:
  • Phone: 352-610-4410
  • Fax: 352-610-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OLUBODE OLATUNJI
Title or Position: PRESIDENT
Credential:
Phone: 352-610-4410