Glendale Prescription Center Inc

Primary specialty

Specialty PharmacyTaxonomy code 3336S0011X

License

8506042 Issued in WI

Legal business name

GLENDALE PRESCRIPTION CENTER INC

Practice address

5322 N Port Washington Rd
Glendale, WI 53217-4913

Phone

(414) 967-9248

Fax

(414) 967-9548

NPI assigned

Jun 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Monica Marie Zatarski

Title

Owner President

Phone

(414) 967-9248

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MD CUSTOM RX Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114960994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5322 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5322 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174913",
            "telephone_number": "414-967-9248",
            "fax_number": "414-967-9548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE PRESCRIPTION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZATARSKI",
        "authorized_official_first_name": "MONICA MARIE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "414-967-9248"
    },
    "taxonomies": [
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "WI",
            "license": "8506042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5128738",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD CUSTOM RX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialty Pharmacy in Glendale, WI
• Providers in Glendale, WI by specialty
• Specialty Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.