Healthcare Provider Details

I. General information

NPI: 1336675578
Provider Name (Legal Business Name): CGL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 56TH ST
PITTSBURGH PA
15201-2322
US

IV. Provider business mailing address

450 56TH ST
PITTSBURGH PA
15201-2322
US

V. Phone/Fax

Practice location:
  • Phone: 412-772-1350
  • Fax: 412-772-1354
Mailing address:
  • Phone: 412-772-1350
  • Fax: 412-772-1354

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 NumberPP482720
License Number StatePA

VIII. Authorized Official

Name: MICHAEL GRABOWSKI
Title or Position: RPH/OWNER
Credential:
Phone: 412-657-5167