Provider Demographics
NPI:1033160551
Name:ELDRIDGE, GLENN (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PATRICK PL
Mailing Address - Street 2:SUITE F
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2110
Mailing Address - Country:US
Mailing Address - Phone:765-858-6600
Mailing Address - Fax:800-228-0844
Practice Address - Street 1:675 PATRICK PL
Practice Address - Street 2:SUITE F
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2110
Practice Address - Country:US
Practice Address - Phone:765-858-6600
Practice Address - Fax:800-228-0844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017239A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist