Provider Demographics
NPI:1871861492
Name:HOWELL, GLEN ROY (RPH)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:ROY
Last Name:HOWELL
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 1:180 PASSAIC AVE
Mailing Address - Street 2:UNIT B-5
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-3516
Mailing Address - Country:US
Mailing Address - Phone:973-461-1561
Mailing Address - Fax:412-717-9065
Practice Address - Street 1:180 PASSAIC AVE
Practice Address - Street 2:UNIT B-5
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3516
Practice Address - Country:US
Practice Address - Phone:973-461-1561
Practice Address - Fax:412-717-9065
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59086183500000X
HIPH-2541183500000X
FLPS30131183500000X
TX49621183500000X
AZS018342183500000X
OR0012508183500000X
CO18987183500000X
ARPD11534183500000X
LAPST.019357183500000X
NE13773183500000X
TN10851183500000X
NY043429-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist