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NPI Code Detail

MEDICARE: GOLUB CORPORATION

MEDICARE: GOLUB CORPORATION
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
13336S0011XSpecialty Pharmacy
23336C0003XCommunity/Retail Pharmacy031738NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12138486OTHERPK

General Provider Information

NPI Number : 1952647778
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLUB CORPORATION
Provider Business Mailing Address
First Line : 461 NOTT ST
Second Line : MB#202
City : SCHENECTADY
State : NY
Zip : 12308-1812
Country : US
Telephone Number : 518-379-1618
Fax Number : 518-356-6978
Provider Business Practice Location Address
First Line : 34 CHENANGO AVE
Second Line :
City : CLINTON
State : NY
Zip : 13323-1341
Country : US
Telephone Number : 315-381-3386
Fax Number : 315-381-3392
Authorized Official
Title or Position : VP OF PHARMACY
Name : KATHLEEN BRYANT
Credential :
Telephone Number : 518-379-1122
Provider Enumeration Date : 12/26/2012
Last Update Date : 07/22/2015

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