Provider Demographics
NPI:1134381585
Name:MEDLEY, GLENN NORRIS (RPH)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:NORRIS
Last Name:MEDLEY
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 1:878 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2135
Mailing Address - Country:US
Mailing Address - Phone:859-266-1171
Mailing Address - Fax:859-266-7603
Practice Address - Street 1:878 E HIGH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2135
Practice Address - Country:US
Practice Address - Phone:859-266-1171
Practice Address - Fax:859-266-7603
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist