Organization
GLEN ED PHARMACY LLC
Active
Other names
Glen Ed Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID RIECK (OWNER)
(314) 542-0022
Entity
Organization
Contact information
Practice address
1 GINGER CREEK MDWS, GLEN CARBON, IL 62034-3508
(618) 655-9898
(618) 655-0230
Mailing address
1 GINGER CREEK MDWS, GLEN CARBON, IL 62034-3508
(618) 655-9898
(618) 655-0230
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.018063
IL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1484308
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/23/2010
Last updated
03/12/2013
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