Provider Demographics
NPI:1588229447
Name:JABAAY, GLENN (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:JABAAY
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 W MANITOBA DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2019
Mailing Address - Country:US
Mailing Address - Phone:708-949-1891
Mailing Address - Fax:
Practice Address - Street 1:7515 W MANITOBA DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2019
Practice Address - Country:US
Practice Address - Phone:708-949-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017126A183500000X
IL051037911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist