Healthcare Provider Details

I. General information

NPI: 1649274168
Provider Name (Legal Business Name): GLEN CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 NORRISTOWN RD
MAPLE GLEN PA
19002-2921
US

IV. Provider business mailing address

1969 NORRISTOWN RD
MAPLE GLEN PA
19002-2921
US

V. Phone/Fax

Practice location:
  • Phone: 215-643-2880
  • Fax: 215-643-7544
Mailing address:
  • Phone: 215-643-2880
  • Fax: 215-643-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413113L
License Number StatePA

VIII. Authorized Official

Name: GREG DIEHL
Title or Position: OWNER
Credential: RPH
Phone: 215-643-2880