Provider Demographics
NPI:1336484021
Name:GLORIA PHARMACY, INC.
Entity Type:Organization
Organization Name:GLORIA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRASIMIRA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:STOYANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-807-5271
Mailing Address - Street 1:1141 KASTING LN
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-9147
Mailing Address - Country:US
Mailing Address - Phone:773-807-5271
Mailing Address - Fax:847-566-6878
Practice Address - Street 1:8336 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3152
Practice Address - Country:US
Practice Address - Phone:773-807-5271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy