Provider Demographics
NPI:1205130291
Name:KRAMER, GLENN ALAN (RPH)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:ALAN
Last Name:KRAMER
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 1:4 WHEATSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2516
Mailing Address - Country:US
Mailing Address - Phone:845-638-0178
Mailing Address - Fax:
Practice Address - Street 1:309 ST ANNS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2589
Practice Address - Country:US
Practice Address - Phone:718-993-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist