Provider Demographics
NPI:1376680538
Name:ALLRED, GLENDA PETERSON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:PETERSON
Last Name:ALLRED
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3131
Mailing Address - Country:US
Mailing Address - Phone:831-385-3259
Mailing Address - Fax:831-385-3928
Practice Address - Street 1:425 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3131
Practice Address - Country:US
Practice Address - Phone:831-385-3259
Practice Address - Fax:831-385-3928
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist