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Organization
GLENWOOD PHARMACY, INC
Active
Organization
GLENWOOD PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA PETERSON (PRESIDENT)
(208) 476-5727
Entity
Organization
Contact information
Practice address
1105 MICHIGAN AVE, OROFINO, ID 83544-9005
(208) 476-5727
(208) 476-4045
Mailing address
1105 MICHIGAN AVE, OROFINO, ID 83544-9005
(208) 476-5727
(208) 476-4045
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2006CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002501800
—
ID
05
—
002593600
—
ID
01
—
1303495
NABP
—
Enumeration date
06/27/2005
Last updated
07/15/2013
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