Provider Demographics
NPI:1336436237
Name:GLAD RX LLC
Entity Type:Organization
Organization Name:GLAD RX LLC
Other - Org Name:GLAD RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-739-7241
Mailing Address - Street 1:216 N ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-8828
Mailing Address - Country:US
Mailing Address - Phone:570-739-7142
Mailing Address - Fax:
Practice Address - Street 1:216 N ROUTE 183
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-8828
Practice Address - Country:US
Practice Address - Phone:570-739-7142
Practice Address - Fax:570-739-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4821353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3995656OtherNCPDP PROVIDER IDENTIFICATION NUMBER