Provider Demographics
NPI:1386698371
Name:GLM PHARMACY
Entity type:Organization
Organization Name:GLM PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH SP
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MC CANN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-801-4413
Mailing Address - Street 1:82 GLEN COVE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1039
Mailing Address - Country:US
Mailing Address - Phone:516-801-4413
Mailing Address - Fax:516-801-4416
Practice Address - Street 1:82 GLEN COVE RD STE 14
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1039
Practice Address - Country:US
Practice Address - Phone:516-801-4413
Practice Address - Fax:516-801-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030936332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00264044Medicaid
NY0479420001Medicare NSC