Healthcare Provider Details

I. General information

NPI: 1710968144
Provider Name (Legal Business Name): JOHN GLAVICIC RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LA CRUE AVE
CONCORDVILLE PA
19331
US

IV. Provider business mailing address

16 MALLARD MILL RUN
WALLINGFORD PA
19086-6670
US

V. Phone/Fax

Practice location:
  • Phone: 610-558-1100
  • Fax: 610-558-1105
Mailing address:
  • Phone: 610-558-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP413696L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: