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NPI Code Detail

MEDICARE: BIANCA GLAB PHARMD

MEDICARE: BIANCA GLAB PHARMD
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
1183500000XPharmacistS024728AZ

General Provider Information

NPI Number : 1205445970
Entity Type Code : Individual
Provider Name (Legal Business Name) : BIANCA GLAB PHARMD
Provider Business Mailing Address
First Line : 2737 E MCKELLIPS RD
Second Line :
City : MESA
State : AZ
Zip : 85213-3016
Country : US
Telephone Number : 480-835-0970
Fax Number :
Provider Business Practice Location Address
First Line : 2737 E MCKELLIPS RD
Second Line :
City : MESA
State : AZ
Zip : 85213-3016
Country : US
Telephone Number : 480-835-0970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2020
Last Update Date : 07/30/2020

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