Provider Demographics
NPI:1841573284
Name:MORIN, GLENN P (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:P
Last Name:MORIN
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 1:215 PALM COAST PKWY NE
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8218
Mailing Address - Country:US
Mailing Address - Phone:386-986-2824
Mailing Address - Fax:386-986-2867
Practice Address - Street 1:215 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8218
Practice Address - Country:US
Practice Address - Phone:386-986-2824
Practice Address - Fax:386-986-2867
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS10752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist