Provider Demographics
NPI:1295518843
Name:GLOMBOWSKI, JAMES MAURITZ (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MAURITZ
Last Name:GLOMBOWSKI
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 1:10443 E MUNRO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEVERING
Mailing Address - State:MI
Mailing Address - Zip Code:49755-8504
Mailing Address - Country:US
Mailing Address - Phone:989-330-7840
Mailing Address - Fax:
Practice Address - Street 1:3944 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5135
Practice Address - Country:US
Practice Address - Phone:231-238-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist