MEDICARE: GLEN CARE PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1942778238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN CARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	2730 COUNTRY CLUB RD STE G1
Second Line	:
City	:	LUCAS
State	:	TX
Zip	:	75002-8781
Country	:	US
Telephone Number	:	214-973-5784
Fax Number	:	214-722-0546

Provider Business Practice Location Address
First Line	:	2730 COUNTRY CLUB RD STE G1
Second Line	:
City	:	LUCAS
State	:	TX
Zip	:	75002-8781
Country	:	US
Telephone Number	:	214-973-5784
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL FRANKEL
Credential	:
Telephone Number	:	214-973-5784

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	08/12/2020

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