Provider Demographics
NPI:1851678775
Name:ADAIR, GLENN ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALLEN
Last Name:ADAIR
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 1:6958 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7034
Mailing Address - Country:US
Mailing Address - Phone:662-890-5047
Mailing Address - Fax:662-890-5058
Practice Address - Street 1:6958 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7034
Practice Address - Country:US
Practice Address - Phone:662-890-5047
Practice Address - Fax:662-890-5058
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE59171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist