MEDICARE: GLENBYRNE 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	332B00000X	Durable Medical Equipment & Medical Supplies		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316902125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENBYRNE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1544 S BYRNE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614
Country	:	US
Telephone Number	:	419-385-5705
Fax Number	:	419-385-5112

Provider Business Practice Location Address
First Line	:	1544 S BYRNE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614
Country	:	US
Telephone Number	:	419-385-5705
Fax Number	:	419-385-5112

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLARD MCCALL
Credential	:
Telephone Number	:	419-385-5705

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	08/22/2020

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