Healthcare Provider Details

I. General information

NPI: 1114960994
Provider Name (Legal Business Name): GLENDALE PRESCRIPTION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5322 N PORT WASHINGTON RD
GLENDALE WI
53217-4913
US

IV. Provider business mailing address

5322 N PORT WASHINGTON RD
GLENDALE WI
53217-4913
US

V. Phone/Fax

Practice location:
  • Phone: 414-967-9248
  • Fax: 414-967-9548
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number8506042
License Number StateWI

VIII. Authorized Official

Name: MONICA MARIE ZATARSKI
Title or Position: OWNER PRESIDENT
Credential:
Phone: 414-967-9248