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General NPI Number Information
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NPI Number | 1427204858
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Entity Type | Organization
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Legal Business Name | GLENDALE PHARMACY INC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 6116 COOPER AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6115
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Country | US
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Telephone | 718-381-0886
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Fax | 718-381-0568
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Provider Business Mailing Address
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Address Line | 142-02 20TH AVENUE
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City | FLUSHING
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State | NY
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Zip | 11351-9712
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Country | US
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Telephone | 718-559-0516
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Fax | 718-762-6140
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Authorized Official
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Title or Position | SR. VP/CFO
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Name | MR. JOE P BLOSS
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Credential |
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Telephone | 718-559-0534
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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 | 029262
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License Number State | NY
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