Glen Ed Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054.018063 Issued in IL

Legal business name

GLEN ED PHARMACY LLC

Doing business as

Glen Ed Pharmacy, LLC

Practice address

1 Ginger Creek MDWS
Glen Carbon, IL 62034-3508

Phone

(618) 655-9898

Fax

(618) 655-0230

NPI assigned

Apr 23, 2010

Organization subpart

No

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

Authorized official

Name

David Rieck

Title

Owner

Phone

(314) 542-0022

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Glen Ed Pharmacy, LLC Doing business as

Locations

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1699092122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GINGER CREEK MDWS",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343508",
            "telephone_number": "618-655-9898",
            "fax_number": "618-655-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GINGER CREEK MDWS",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343508",
            "telephone_number": "618-655-9898",
            "fax_number": "618-655-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ED PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "RIECK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-542-0022"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.018063",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1484308",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Ed Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelsey Giger
• Victoria Elise Ginder, LCSW, MSW
• Ginger Creek Dental LLC
• Harlan Lorenzo Glasper III
• Glen Carbon Fire Protection District
• Kristin Goeb
• Sarah Goshorn
• Alexandra Lynn Goss, RBT
• Michael Francis Gowen, MD
• Marissa Gowey, PHD

• Community/Retail Pharmacy in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; 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.