Provider Demographics
NPI:1821252529
Name:GLAZNER, H PHILLIP (R PH)
Entity Type:Individual
Prefix:MR
First Name:H
Middle Name:PHILLIP
Last Name:GLAZNER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 OLD MILL RUN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6160
Mailing Address - Country:US
Mailing Address - Phone:386-677-0215
Mailing Address - Fax:
Practice Address - Street 1:921 OLD MILL RUN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6160
Practice Address - Country:US
Practice Address - Phone:386-677-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU 14381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPU 1438OtherFLORIDA CONSULTAMT PHARMACY LICENSEE
GARPH011308OtherGEORGIA PHARMACY LIC. NUMBER
FLPS14502OtherFLORIDA PHARMACY LIC NUMBER