Provider Demographics
NPI:1598131369
Name:WARCISKI, GLENN (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:WARCISKI
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 1:10974 JOOR RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3911
Mailing Address - Country:US
Mailing Address - Phone:225-261-4530
Mailing Address - Fax:225-261-1622
Practice Address - Street 1:10974 JOOR RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3911
Practice Address - Country:US
Practice Address - Phone:225-261-4530
Practice Address - Fax:225-261-1622
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist