Provider Demographics
NPI:1093316044
Name:CONFORT, GLENN CURTIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:CURTIS
Last Name:CONFORT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6932 N ROCKVALE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2341
Mailing Address - Country:US
Mailing Address - Phone:309-693-9854
Mailing Address - Fax:
Practice Address - Street 1:8915 N ALLEN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1534
Practice Address - Country:US
Practice Address - Phone:309-693-9854
Practice Address - Fax:309-693-9862
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2989361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist