Healthcare Provider Details

I. General information

NPI: 1598760639
Provider Name (Legal Business Name): GLENDALE PRESCRIPTION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 CASTOR AVE STE 100 LOBBY
PHILADELPHIA PA
19152-4026
US

IV. Provider business mailing address

7601 CASTOR AVE STE 100 LOBBY
PHILADELPHIA PA
19152-4026
US

V. Phone/Fax

Practice location:
  • Phone: 215-722-6200
  • Fax: 215-722-6211
Mailing address:
  • Phone: 215-722-6200
  • Fax: 215-722-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481117
License Number StatePA

VIII. Authorized Official

Name: STEVE TAMMARA
Title or Position: PHARMACIST OWNER
Credential: BS
Phone: 215-722-6200