Provider Demographics
NPI:1689113821
Name:GLENWOOD PHARMACY LLC
Entity Type:Organization
Organization Name:GLENWOOD PHARMACY LLC
Other - Org Name:PHARM-D RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ILOMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:YADGAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-743-3300
Mailing Address - Street 1:312 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-743-3300
Mailing Address - Fax:973-743-3303
Practice Address - Street 1:312 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-743-3300
Practice Address - Fax:973-743-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007547003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168184OtherPK