Provider Demographics
NPI:1942579651
Name:GLIDDON, REID MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:REID
Middle Name:MATTHEW
Last Name:GLIDDON
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 1:2627 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2610
Mailing Address - Country:US
Mailing Address - Phone:562-490-9575
Mailing Address - Fax:562-490-2896
Practice Address - Street 1:2627 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2610
Practice Address - Country:US
Practice Address - Phone:562-490-9575
Practice Address - Fax:562-490-2896
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH038238183500000X
WI10282-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist