Healthcare Provider Details

I. General information

NPI: 1306795810
Provider Name (Legal Business Name): DAVID JESSE GLENN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 W MAIN ST
AMERICAN FORK UT
84003-9762
US

IV. Provider business mailing address

347 W HIDDEN HOLLOW DR
OREM UT
84058-7552
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-5997
  • Fax:
Mailing address:
  • Phone: 801-372-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7452155-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: