Organization
EDEN PARK PHARMACY SUPPLY CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GLOCK (PRESIDENT)
(518) 436-4731
Entity
Organization
Contact information
Practice address
16 WALKER WAY, ALBANY, NY 12205-4995
(518) 452-7795
Mailing address
22 HOLLAND AVE, ALBANY, NY 12209-1713
(518) 436-4731
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
022310
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02068037
—
NY
Enumeration date
11/16/2006
Last updated
08/22/2020
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