Provider Demographics
NPI:1578294906
Name:FOREMAN, GLYN JOSEPH II (RPH)
Entity Type:Individual
Prefix:
First Name:GLYN
Middle Name:JOSEPH
Last Name:FOREMAN
Suffix:II
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 1:3113 JUG SAYS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-3348
Mailing Address - Country:US
Mailing Address - Phone:337-217-3258
Mailing Address - Fax:
Practice Address - Street 1:701 CYPRESS ST STE 4000
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5053
Practice Address - Country:US
Practice Address - Phone:337-527-4174
Practice Address - Fax:337-527-4128
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.016154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist