Provider Demographics
NPI:1568189967
Name:SOMERA, GLENN TRISTAN
Entity Type:Individual
Prefix:
First Name:GLENN TRISTAN
Middle Name:
Last Name:SOMERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 FOXLAND CHASE ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5327
Mailing Address - Country:US
Mailing Address - Phone:281-636-5378
Mailing Address - Fax:
Practice Address - Street 1:3103 FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6218
Practice Address - Country:US
Practice Address - Phone:281-646-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist