Provider Demographics
NPI:1083996722
Name:GLENN, SHELIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4122
Mailing Address - Country:US
Mailing Address - Phone:276-781-7811
Mailing Address - Fax:276-781-7817
Practice Address - Street 1:1102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4122
Practice Address - Country:US
Practice Address - Phone:276-781-7811
Practice Address - Fax:276-781-7817
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist