Provider Demographics
NPI:1790371243
Name:FITCH, GLENN (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:FITCH
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 1:204 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7803
Mailing Address - Country:US
Mailing Address - Phone:401-943-8285
Mailing Address - Fax:401-943-8684
Practice Address - Street 1:204 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7803
Practice Address - Country:US
Practice Address - Phone:401-943-8285
Practice Address - Fax:401-943-8684
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist