Provider Demographics
NPI:1275827867
Name:GLENN, DAVID R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:GLENN
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 1:1550 N SATE STREET
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-0000
Mailing Address - Country:US
Mailing Address - Phone:801-762-0396
Mailing Address - Fax:
Practice Address - Street 1:1550 NORTH SATE STREET
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-0000
Practice Address - Country:US
Practice Address - Phone:801-762-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6253810-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist