Provider Demographics
NPI:1821323759
Name:GLORY GLOBAL GROUP INCORPORATION
Entity Type:Organization
Organization Name:GLORY GLOBAL GROUP INCORPORATION
Other - Org Name:GLORY GLOBAL GROUP INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUBODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLATUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-610-4410
Mailing Address - Street 1:5192 MARINER BLVD.
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:352-610-4410
Mailing Address - Fax:352-610-4411
Practice Address - Street 1:5192 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1802
Practice Address - Country:US
Practice Address - Phone:352-610-4410
Practice Address - Fax:352-610-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1050385OtherNCPDP PROVIDER IDENTIFICATION NUMBER