Provider Demographics
NPI:1952649378
Name:GAINES, GLENDA R (RPH)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:R
Last Name:GAINES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 CORINTHIAN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9585
Mailing Address - Country:US
Mailing Address - Phone:336-540-0677
Mailing Address - Fax:
Practice Address - Street 1:4804 CORINTHIAN WAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9585
Practice Address - Country:US
Practice Address - Phone:336-540-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15219183500000X
MA20193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist