Provider Demographics
NPI:1649274168
Name:GLEN CENTER PHARMACY
Entity type:Organization
Organization Name:GLEN CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-643-2880
Mailing Address - Street 1:1969 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2921
Mailing Address - Country:US
Mailing Address - Phone:215-643-2880
Mailing Address - Fax:215-643-7544
Practice Address - Street 1:1969 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2921
Practice Address - Country:US
Practice Address - Phone:215-643-2880
Practice Address - Fax:215-643-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP413113L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3961681OtherOTHER ID NUMBER
PA0739000001Medicare NSC