Provider Demographics
NPI:1114232675
Name:HOWARD, GLENN THOMPSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:THOMPSON
Last Name:HOWARD
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 1:117 BLACKBIRD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-5447
Mailing Address - Country:US
Mailing Address - Phone:830-223-5324
Mailing Address - Fax:
Practice Address - Street 1:117 BLACKBIRD DR
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-5447
Practice Address - Country:US
Practice Address - Phone:830-223-5324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist