Provider Demographics
NPI:1720550791
Name:GLEN BURNIE PHARMACY
Entity Type:Organization
Organization Name:GLEN BURNIE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NYE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:856-506-1836
Mailing Address - Street 1:85 KINDRED WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5246
Mailing Address - Country:US
Mailing Address - Phone:410-553-6100
Mailing Address - Fax:
Practice Address - Street 1:85 KINDRED WAY APT 102
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5246
Practice Address - Country:US
Practice Address - Phone:410-553-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy