Organization
GLIDDONS DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH GUSTAGSON RPH (PRESIDENT/OWNER)
(630) 365-6500
Entity
Organization
Contact information
Practice address
116 N MAIN ST, ELBURN, IL 60119-9112
(630) 365-6500
(630) 365-6522
Mailing address
116 N MAIN ST, ELBURN, IL 60119-9112
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1421902
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/12/2006
Last updated
09/11/2025
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