Healthcare Provider Details

I. General information

NPI: 1962411918
Provider Name (Legal Business Name): GLENN ALEXANDER FRUM R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 SECOND AVE.
GOLD HILL OR
97525
US

IV. Provider business mailing address

PO BOX 259
GOLD HILL OR
97525-0259
US

V. Phone/Fax

Practice location:
  • Phone: 541-855-1544
  • Fax: 541-855-1040
Mailing address:
  • Phone: 541-855-1544
  • Fax: 541-855-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5852
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: