Provider Demographics
NPI:1811646805
Name:GLENDALE PHARMACY, LLC
Entity type:Organization
Organization Name:GLENDALE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ARMYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-595-3355
Mailing Address - Street 1:12444 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3042
Mailing Address - Country:US
Mailing Address - Phone:757-595-3355
Mailing Address - Fax:757-596-1863
Practice Address - Street 1:12444 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3042
Practice Address - Country:US
Practice Address - Phone:757-595-3355
Practice Address - Fax:757-596-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy