Healthcare Provider Details

I. General information

NPI: 1952998361
Provider Name (Legal Business Name): GLENN WOOD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOUSTON AVE
PERRYVILLE AR
72126-9451
US

IV. Provider business mailing address

PO BOX 435
PERRYVILLE AR
72126-0435
US

V. Phone/Fax

Practice location:
  • Phone: 501-889-5111
  • Fax:
Mailing address:
  • Phone: 501-889-5111
  • Fax: 501-889-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10345
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: