Provider Demographics
NPI:1932187796
Name:LICHTMAN, GLENN H (RPH)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:H
Last Name:LICHTMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1416
Mailing Address - Country:US
Mailing Address - Phone:410-653-7305
Mailing Address - Fax:
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-653-7305
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09370183500000X
PARP041929R183500000X
NJ28R102927900183500000X
DCPH2367183500000X
DEA1-0003274183500000X
VA0202011681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist