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	183500000X	Pharmacist	48153379	OH

General Provider Information

NPI Number	:	1821123373
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	:	43614-3465
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	:	43614-3465
Country	:	US
Telephone Number	:	419-385-5705
Fax Number	:	419-385-5112

Authorized Official
Title or Position	:	REGISTERED NURSE, DIABETIC EDUCATOR
Name	:	MS. IRENE BROOKS
Credential	:	RN, MED, CDE
Telephone Number	:	419-385-5705

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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