MEDICARE: GOLUB CORPORATION

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
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy	021053	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2067113	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346253648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLUB CORPORATION

Provider Business Mailing Address
First Line	:	461 NOTT ST
Second Line	:	MB#202
City	:	SCHENECTADY
State	:	NY
Zip	:	12308-1812
Country	:	US
Telephone Number	:	518-379-1618
Fax Number	:	518-356-6978

Provider Business Practice Location Address
First Line	:	3045 ROUTE 50
Second Line	:
City	:	SARATOGA SPGS
State	:	NY
Zip	:	12866-2919
Country	:	US
Telephone Number	:	518-583-3697
Fax Number	:	518-583-3110

Authorized Official
Title or Position	:	VP OF PHARMACY
Name	:	KATHLEEN BRYANT
Credential	:
Telephone Number	:	518-379-1122

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/22/2015

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Directions to “GOLUB CORPORATION ” Practice Location

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