Provider Demographics
NPI:1669968442
Name:GLENN POWERS MD PHARMD
Entity type:Organization
Organization Name:GLENN POWERS MD PHARMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHARMD
Authorized Official - Phone:206-369-4855
Mailing Address - Street 1:708 SW 199TH PL
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98166-4151
Mailing Address - Country:US
Mailing Address - Phone:206-369-4855
Mailing Address - Fax:
Practice Address - Street 1:3260 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-796-8412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK127388207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty