Provider Demographics
NPI:1689301855
Name:HARLINE, GLEN ALDEN (RPH)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:ALDEN
Last Name:HARLINE
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 1:4727 W SOUTH JORDAN PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1708
Mailing Address - Country:US
Mailing Address - Phone:385-297-9740
Mailing Address - Fax:385-297-9741
Practice Address - Street 1:4727 W SOUTH JORDAN PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-1708
Practice Address - Country:US
Practice Address - Phone:385-297-9740
Practice Address - Fax:385-297-9741
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT276895-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist