MEDICARE: GLENDALE PRESCRIPTION CENTER 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	333600000X	Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PP481117	PA

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
2	2085890	OTHER		PK

General Provider Information

NPI Number	:	1598760639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE PRESCRIPTION CENTER INC

Provider Business Mailing Address
First Line	:	7601 CASTOR AVE
Second Line	:	STE 100 LOBBY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-4026
Country	:	US
Telephone Number	:	215-722-6200
Fax Number	:	215-722-6211

Provider Business Practice Location Address
First Line	:	7601 CASTOR AVE
Second Line	:	STE 100 LOBBY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-4026
Country	:	US
Telephone Number	:	215-722-6200
Fax Number	:	215-722-6211

Authorized Official
Title or Position	:	PHARMACIST OWNER
Name	:	STEVE TAMMARA
Credential	:	BS
Telephone Number	:	215-722-6200

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/04/2016

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Directions to “GLENDALE PRESCRIPTION CENTER INC ” Practice Location

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