Provider Demographics
NPI:1407259435
Name:KRENELKA, GLEN (RPH)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:KRENELKA
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 1:3720 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2543
Mailing Address - Country:US
Mailing Address - Phone:651-895-0783
Mailing Address - Fax:
Practice Address - Street 1:1131 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2216
Practice Address - Country:US
Practice Address - Phone:218-724-3060
Practice Address - Fax:218-724-1853
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist