MEDICARE: MR. GLENN ALEXANDER FRUM R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5852	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5852	OTHER	OR	LICENSE NUMBER

General Provider Information

NPI Number	:	1962411918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN ALEXANDER FRUM R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 259
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525-0259
Country	:	US
Telephone Number	:	541-855-1544
Fax Number	:	541-855-1040

Provider Business Practice Location Address
First Line	:	808 SECOND AVE.
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525
Country	:	US
Telephone Number	:	541-855-1544
Fax Number	:	541-855-1040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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