=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467663039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLASSMANS PRESCRIPTION PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 893 MAIN ST
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-523-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 893 MAIN ST
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER REG PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MR. BENJAMIN M GLASSMAN
-----------------------------------------------------
Credential | RP
-----------------------------------------------------
Telephone | 973-523-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 28RS00138400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------