Provider Demographics
NPI:1619123510
Name:MARCUM, GLENN C (RPH)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:C
Last Name:MARCUM
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 1:130 W LOUDON AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1412
Mailing Address - Country:US
Mailing Address - Phone:859-281-9660
Mailing Address - Fax:859-281-6627
Practice Address - Street 1:130 W LOUDON AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1412
Practice Address - Country:US
Practice Address - Phone:859-281-9660
Practice Address - Fax:859-281-6627
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist