Active NPI
Glenn Herskowitz, PHARM
- Pharmacist
- San Mateo, CA
National Provider Identifier
1871964569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 38475
- Practice address
- 225 37TH Ave FL 3
San Mateo, CA 94403-4324 - Phone
- (650) 573-2296
- NPI assigned
- Oct 7, 2015
- Reactivated
- Nov 14, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9078 | NV | |
| Pharmacist | 183500000X | 38475 | CA | Primary |
Addresses
Primary practice location
225 37TH Ave FL 3
San Mateo, CA 94403-4324
Mailing address
PO Box 5155
Larkspur, CA 94977-5155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38475 | CA | MD | Pharmacist |
| 9078 | NV | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731542400000",
"number": "1871964569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5155",
"city": "LARKSPUR",
"state": "CA",
"postal_code": "949775155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 37TH AVE FL 3",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944034324",
"telephone_number": "650-573-2296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERSKOWITZ",
"first_name": "GLENN",
"credential": "PHARM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-07",
"last_updated": "2024-11-14",
"deactivation_date": "2019-04-01",
"reactivation_date": "2024-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "9078",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "38475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.