Provider Demographics
NPI:1134596398
Name:GLEGHORN, JOHN CHAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHAD
Last Name:GLEGHORN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1870
Mailing Address - Country:US
Mailing Address - Phone:417-256-7706
Mailing Address - Fax:
Practice Address - Street 1:1453 GIBSON ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1870
Practice Address - Country:US
Practice Address - Phone:417-256-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist