Provider Demographics
NPI:1891934824
Name:WALSKI, GLENN C (RPH)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:C
Last Name:WALSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4017
Mailing Address - Country:US
Mailing Address - Phone:845-344-1056
Mailing Address - Fax:
Practice Address - Street 1:245 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4017
Practice Address - Country:US
Practice Address - Phone:845-344-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-14
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist