Provider Demographics
NPI:1295373512
Name:GLENN, GUY COLEMAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:COLEMAN
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 1:369 COUNTY ROAD 231
Mailing Address - Street 2:
Mailing Address - City:GUNTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:38849-6112
Mailing Address - Country:US
Mailing Address - Phone:662-255-1446
Mailing Address - Fax:
Practice Address - Street 1:930 BARNES CROSSING RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0910
Practice Address - Country:US
Practice Address - Phone:662-844-5247
Practice Address - Fax:662-844-5417
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-13550183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist