MEDICARE: GLORY GLOBAL GROUP INCORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336M0002X	Mail Order Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1050385	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1821323759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORY GLOBAL GROUP INCORPORATION

Provider Business Mailing Address
First Line	:	5192 MARINER BLVD.
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	33609
Country	:	US
Telephone Number	:	352-610-4410
Fax Number	:	352-610-4411

Provider Business Practice Location Address
First Line	:	5192 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1802
Country	:	US
Telephone Number	:	352-610-4410
Fax Number	:	352-610-4411

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLUBODE OLATUNJI
Credential	:
Telephone Number	:	352-610-4410

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	11/23/2009

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