Provider Demographics
NPI:1245344779
Name:GLYNN, LLOYD E (RPH)
Entity type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:E
Last Name:GLYNN
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 1:2777 DOWNDA RD
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9449
Mailing Address - Country:US
Mailing Address - Phone:715-356-6696
Mailing Address - Fax:
Practice Address - Street 1:2777 DOWNDA RD
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568-9449
Practice Address - Country:US
Practice Address - Phone:715-356-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9546040183500000X
WI9546-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist