Healthcare Provider Details

I. General information

NPI: 1275646655
Provider Name (Legal Business Name): GOLUB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TOWN SQUIRE PLAZA 329 GLENMONT RD
GLENMONT NY
12077
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 518-433-4711
  • Fax: 518-433-4715
Mailing address:
  • Phone: 518-379-1618
  • Fax: 518-356-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number025399
License Number StateNY

VIII. Authorized Official

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