Provider Demographics
NPI:1841255130
Name:ALBRACHT, GLEN (RPH, MS)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:ALBRACHT
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-7756
Mailing Address - Country:US
Mailing Address - Phone:704-633-0926
Mailing Address - Fax:704-638-3396
Practice Address - Street 1:VA MEDICAL CENTER (119)
Practice Address - Street 2:1601 BRENNER AVENUE
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-638-3441
Practice Address - Fax:704-638-3396
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist