=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366586828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLEN ROCK HEALTH CARE ENTERPRISES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2007
-----------------------------------------------------
Last Update Date | 10/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 644 GODWIN AVE. #2 GODWIN PLAZA
-----------------------------------------------------
City | MIDLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07432-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-689-2252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 644 GODWIN AVE. #2 GODWIN PLAZA
-----------------------------------------------------
City | MIDLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07432-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-689-2252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOYCE LAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-689-2252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00588600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------