# GLENDALE PRESCRIPTION CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MD CUSTOM RX
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114960994
- **Authorized official:** MONICA MARIE ZATARSKI (OWNER PRESIDENT)
- **Authorized official phone:** (414) 967-9248

## Contact information

- **Practice address:** 5322 N PORT WASHINGTON RD, GLENDALE, WI 53217-4913
- **Practice address phone:** (414) 967-9248
- **Practice address fax:** (414) 967-9548
- **Mailing address:** 5322 N PORT WASHINGTON RD, GLENDALE, WI 53217-4913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336S0011X | Specialty Pharmacy | 8506042 | WI | Yes |

## Other

- **Enumeration date:** 06/13/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5128738 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |