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General NPI Number Information
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NPI Number | 1659431948
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Entity Type | Organization
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Legal Business Name | GLENN DRUG INC
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Dates
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Enumeration Date | 12/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 401 W MAIN ST
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-3018
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Country | US
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Telephone | 501-362-2633
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Fax | 501-362-4064
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Provider Business Mailing Address
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Address Line | 401 W MAIN ST
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-3018
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Country | US
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Telephone | 501-362-2633
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Fax | 501-362-4064
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MR. JOHN CLEVE HENDRICKS II
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Credential | PD
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Telephone | 501-362-2633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0420265
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License Number State | AR
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