Provider Demographics
NPI:1427204858
Name:GLENDALE PHARMACY INC
Entity type:Organization
Organization Name:GLENDALE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-559-0534
Mailing Address - Street 1:142-02 20TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351-9712
Mailing Address - Country:US
Mailing Address - Phone:718-559-0516
Mailing Address - Fax:718-762-6140
Practice Address - Street 1:6116 COOPER AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6115
Practice Address - Country:US
Practice Address - Phone:718-381-0886
Practice Address - Fax:718-381-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0292623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3359949OtherNCPDP PROVIDER IDENTIFICATION NUMBER