MEDICARE: GLENN BORDEN

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	PS27542	FL

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

General Provider Information

NPI Number	:	1942889654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN BORDEN

Provider Business Mailing Address
First Line	:	21321 ROCK RIDGE DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4876
Country	:	US
Telephone Number	:	561-706-7803
Fax Number	:	561-241-7711

Provider Business Practice Location Address
First Line	:	4802 NW 2ND AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-4173
Country	:	US
Telephone Number	:	561-241-7711
Fax Number	:	561-241-7717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ GLENN BORDEN ” Practice Location

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