Lynette R Glockner, Inc.
Organization Active NPI Community/Retail Pharmacy · Mathews, VA
NPI 1124500160 · NPPES record last updated Sep 6, 2018
Key facts
- NPI
- 1124500160
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- LYNETTE R GLOCKNER, INC.
- Practice address
- 10858 Buckley Hall Road
Mathews, VA 23109 - Phone
- (804) 725-2556
- Fax
- (804) 725-0786
- NPI assigned
- Sep 6, 2018
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lynette Renae Glockner, RPH
- Title
- Owner/Pharmacist
- Phone
- (330) 221-7450
Practitioners 3
-
Diana Lynn Bandurco, RPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2212040 | Lynette R Glockner Inc | Certificate of waiver | Feb 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190129000970 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668717042 | Practice locations: Mathews, VA |
| O20210105001716 | VA | Part B Supplier - Pharmacy | 2668717042 | Practice locations: Mathews, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
10858 Buckley Hall Road
Mathews, VA 23109
Mailing address
11451 Coveside PT
Gloucester, VA 23061-2576
Phone (330) 221-7450
Other names
- Mathews Pharmacy
Other providers in Mathews, VA
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- Mathews County Public Schools
- Robert A May
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- Kathryn Charles Miles
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All providers in Mathews, VA · Community/Retail Pharmacy in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.