Healthcare Provider Details

I. General information

NPI: 1952647778
Provider Name (Legal Business Name): GOLUB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CHENANGO AVE
CLINTON NY
13323-1341
US

IV. Provider business mailing address

461 NOTT ST MB#202
SCHENECTADY NY
12308-1812
US

V. Phone/Fax

Practice location:
  • Phone: 315-381-3386
  • Fax: 315-381-3392
Mailing address:
  • Phone: 518-379-1618
  • Fax: 518-356-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031738
License Number StateNY

VIII. Authorized Official

Name: KATHLEEN BRYANT
Title or Position: VP OF PHARMACY
Credential:
Phone: 518-379-1122