Organization
GLENDALE PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARMYA R MARAE RPH (PHARMACIST/OWNER)
(757) 595-3355
Entity
Organization
Contact information
Practice address
12444 WARWICK BLVD, NEWPORT NEWS, VA 23606-3042
(757) 595-3355
(757) 596-1863
Mailing address
12444 WARWICK BLVD, NEWPORT NEWS, VA 23606-3042
(757) 595-3355
(757) 596-1863
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0201002006
VA
3336C0003X
Community/Retail Pharmacy
0201002006
VA
3336C0004X
Compounding Pharmacy
0201002006
VA
3336L0003X
Long Term Care Pharmacy
0201002006
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008514305
—
VA
05
—
009123610
—
VA
05
—
7731440001
—
VA
Enumeration date
03/03/2008
Last updated
03/07/2022
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