Provider Demographics
NPI:1053130062
Name:GLADE PHARMACY LLC
Entity type:Organization
Organization Name:GLADE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-429-2004
Mailing Address - Street 1:33472 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:GLADE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24340-5100
Mailing Address - Country:US
Mailing Address - Phone:276-429-2004
Mailing Address - Fax:276-429-2009
Practice Address - Street 1:33472 LEE HWY
Practice Address - Street 2:
Practice Address - City:GLADE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24340-5100
Practice Address - Country:US
Practice Address - Phone:276-429-2004
Practice Address - Fax:276-429-2009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLADE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty