Provider Demographics
NPI:1346889383
Name:GLEM, KATHY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:A
Last Name:GLEM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18865 SPANISH OAK CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-3430
Mailing Address - Country:US
Mailing Address - Phone:206-854-1843
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-606-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60330656183500000X
TX534001835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care
No183500000XPharmacy Service ProvidersPharmacist