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General NPI Number Information
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NPI Number | 1336484021
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Entity Type | Organization
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Legal Business Name | GLORIA PHARMACY, INC.
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 8336 W LAWRENCE AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-3152
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Country | US
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Telephone | 773-807-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 KASTING LN
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City | MUNDELEIN
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State | IL
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Zip | 60060-9147
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Country | US
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Telephone | 773-807-5271
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Fax | 847-566-6878
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRASIMIRA Z STOYANOVA
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Credential | RPH
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Telephone | 773-807-5271
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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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