MEDICARE: GLORY PHARMACY INC.

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	3336L0003X	Long Term Care Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY55669	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5663427	OTHER	CA	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PHY55669	OTHER	CA	PHARMACY PERMIT

General Provider Information

NPI Number	:	1235668906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORY PHARMACY INC.

Provider Business Mailing Address
First Line	:	9675 MONTE VISTA AVE STE A
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9675 MONTE VISTA AVE STE A
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2213
Country	:	US
Telephone Number	:	626-234-3186
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	NORA ISKANDAR
Credential	:
Telephone Number	:	909-542-9365

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	01/15/2026

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Directions to “GLORY PHARMACY INC. ” Practice Location

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