Provider Demographics
NPI:1821123373
Name:GLENBYRNE PHARMACY, INC
Entity Type:Organization
Organization Name:GLENBYRNE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE, DIABETIC EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MED, CDE
Authorized Official - Phone:419-385-5705
Mailing Address - Street 1:1544 S BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3465
Mailing Address - Country:US
Mailing Address - Phone:419-385-5705
Mailing Address - Fax:419-385-5112
Practice Address - Street 1:1544 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3465
Practice Address - Country:US
Practice Address - Phone:419-385-5705
Practice Address - Fax:419-385-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH48153379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGL9313221Medicare ID - Type Unspecified