Provider Demographics
NPI:1205960457
Name:GLEGHORN, REBECCA D (DPH)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:D
Last Name:GLEGHORN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 LEWISBURG HWY
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37144-7640
Mailing Address - Country:US
Mailing Address - Phone:931-659-6989
Mailing Address - Fax:
Practice Address - Street 1:106 ELK AVE S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3050
Practice Address - Country:US
Practice Address - Phone:931-433-1511
Practice Address - Fax:931-433-6854
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist