Provider Demographics
NPI:1831465111
Name:GLENDALE COMMUNITY CARE PHARMACY INC
Entity Type:Organization
Organization Name:GLENDALE COMMUNITY CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VARDUI
Authorized Official - Middle Name:
Authorized Official - Last Name:PNDLYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-268-8833
Mailing Address - Street 1:818 N. PACIFIC AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3632
Mailing Address - Country:US
Mailing Address - Phone:818-956-0044
Mailing Address - Fax:818-956-0042
Practice Address - Street 1:818 N. PACIFIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3632
Practice Address - Country:US
Practice Address - Phone:818-956-0044
Practice Address - Fax:818-956-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies