Provider Demographics
NPI:1265717037
Name:MILLARD, GLENDA (PHARMD)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 N MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7910
Mailing Address - Country:US
Mailing Address - Phone:208-465-6801
Mailing Address - Fax:208-465-6811
Practice Address - Street 1:16300 N MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7910
Practice Address - Country:US
Practice Address - Phone:208-465-6801
Practice Address - Fax:208-465-6811
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10263183500000X
KS1-14975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist