Provider Demographics
NPI:1255462396
Name:GLENN, BEVERLY GENE (RPH)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:GENE
Last Name:GLENN
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 1:113 STONECROFT RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4968
Mailing Address - Country:US
Mailing Address - Phone:423-652-2246
Mailing Address - Fax:
Practice Address - Street 1:1315 EUCLID AVE
Practice Address - Street 2:FOOD CITY PHARMACY
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3834
Practice Address - Country:US
Practice Address - Phone:276-645-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist