=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942365523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN DOWDY RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1114 COTTINGHAM BLVD N
-----------------------------------------------------
City | BENNETTSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29512-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-479-7101
-----------------------------------------------------
Fax | 843-479-3561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1114 COTTINGHAM BLVD N
-----------------------------------------------------
City | BENNETTSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29512-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-479-7101
-----------------------------------------------------
Fax | 843-479-3561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 006428
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------