Provider Demographics
NPI:1437507340
Name:GLOTZBACH PHARMACY LLC
Entity Type:Organization
Organization Name:GLOTZBACH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOTZBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-884-1520
Mailing Address - Street 1:500 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:IN
Mailing Address - Zip Code:47944-1636
Mailing Address - Country:US
Mailing Address - Phone:765-884-1520
Mailing Address - Fax:765-884-8329
Practice Address - Street 1:500 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:IN
Practice Address - Zip Code:47944-1636
Practice Address - Country:US
Practice Address - Phone:765-884-1520
Practice Address - Fax:765-884-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy