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General NPI Number Information
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NPI Number | 1891277711
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Entity Type | Organization
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Legal Business Name | GLENDALE VILLAGE PHARMACY, LLC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 334 S BROAD ST
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City | TRENTON
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State | NJ
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Zip | 08608-2502
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Country | US
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Telephone | 609-571-3565
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Fax | 609-571-3486
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Provider Business Mailing Address
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Address Line | 334 S BROAD ST
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City | TRENTON
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State | NJ
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Zip | 08608-2502
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Country | US
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Telephone | 609-571-3565
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Fax | 609-571-3486
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELINA ELKIND
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Credential | PHARMD
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Telephone | 917-968-1948
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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 | 28RS00766800
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License Number State | NJ
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