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General NPI Number Information
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NPI Number | 1265800726
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Entity Type | Organization
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Legal Business Name | GOLUB CORPORATION
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 2981 FORD STREET EXT SUITE 9
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City | OGDENSBURG
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State | NY
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Zip | 13669-3474
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Country | US
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Telephone | 315-393-7153
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Fax | 866-360-9325
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Provider Business Mailing Address
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Address Line | 461 NOTT ST MB#202
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City | SCHENECTADY
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State | NY
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Zip | 12308-1812
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Country | US
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Telephone | 518-379-1618
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Fax | 518-356-6978
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Authorized Official
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Title or Position | VP OF PHARMACY
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Name | KATHLEEN BRYANT
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Credential |
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Telephone | 518-379-1618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 034221
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License Number State | NY
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