MEDICARE: GLENDALE CHEMIST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1124556196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE CHEMIST LLC

Provider Business Mailing Address
First Line	:	6801 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7267
Country	:	US
Telephone Number	:	718-366-3561
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GIUSTINA LOMBARDO
Credential	:
Telephone Number	:	718-366-3561

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	06/02/2017

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