Organization
ORGLIFE PHARMACY INC
Active
Other names
GLENDALE RX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SHALTS (PIC/CEO)
(818) 500-0411
Entity
Organization
Contact information
Practice address
1030 S GLENDALE AVE, #101 & #102, GLENDALE, CA 91205-5612
(818) 500-0411
(818) 500-7353
Mailing address
1030 S GLENDALE AVE, #101 & #102, GLENDALE, CA 91205-5612
(818) 500-0411
(818) 500-7353
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5629083
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
PHY55726
BOARD OF PHARMACY RETAIL PERMIT
CA
Enumeration date
01/11/2008
Last updated
02/27/2019
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