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Organization
GLENDALE PRESCRIPTION CENTER INC
Active
Organization
GLENDALE PRESCRIPTION CENTER INC
Active
Other names
MD CUSTOM RX
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA MARIE ZATARSKI (OWNER PRESIDENT)
(414) 967-9248
Entity
Organization
Contact information
Practice address
5322 N PORT WASHINGTON RD, GLENDALE, WI 53217-4913
(414) 967-9248
(414) 967-9548
Mailing address
5322 N PORT WASHINGTON RD, GLENDALE, WI 53217-4913
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
8506042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5128738
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/13/2006
Last updated
08/22/2020
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