Provider Demographics
NPI:1841410016
Name:GLEN, MICHAEL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:GLEN
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 1:2200 CORNERSTONE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-9712
Mailing Address - Country:US
Mailing Address - Phone:224-327-8888
Mailing Address - Fax:224-327-8996
Practice Address - Street 1:2200 CORNERSTONE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-9712
Practice Address - Country:US
Practice Address - Phone:224-327-8888
Practice Address - Fax:224-327-8996
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51032659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist