Healthcare Provider Details

I. General information

NPI: 1558712729
Provider Name (Legal Business Name): GLENN HOUGH HERRINGTON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 DOCTORS CIR
WILMINGTON NC
28401-7405
US

IV. Provider business mailing address

1415 PHYSICIANS DR
WILMINGTON NC
28401-7338
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-8736
  • Fax: 910-343-1293
Mailing address:
  • Phone: 910-662-9500
  • Fax: 910-662-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26028
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: