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General NPI Number Information
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NPI Number | 1801397914
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Entity Type | Organization
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Legal Business Name | GLANDER INC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 3529 SUPERIOR AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1865
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Country | US
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Telephone | 920-459-2755
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Fax | 920-803-7519
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Provider Business Mailing Address
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Address Line | 3529 SUPERIOR AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1865
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Country | US
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Telephone | 920-459-2755
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Fax | 920-803-7519
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT BOUCHE
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Credential |
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Telephone | 920-459-2755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 855742
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License Number State | WI
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