Provider Demographics
NPI:1912284290
Name:DAMPIER, GLENN ALVON JR (DPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALVON
Last Name:DAMPIER
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 ELMINGTON AVE
Mailing Address - Street 2:APT. 616
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5162
Mailing Address - Country:US
Mailing Address - Phone:615-957-1597
Mailing Address - Fax:
Practice Address - Street 1:444 ELMINGTON AVE
Practice Address - Street 2:APT 616
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-5162
Practice Address - Country:US
Practice Address - Phone:615-957-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33493183500000X
AL10156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist