Basic Information
Provider Information
NPI: 1003153156
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GLENNON
FirstName: CHRISTOPHER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHARM D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5500 MILITARY TRL
Address2:  
City: JUPITER
State: FL
PostalCode: 334582869
CountryCode: US
TelephoneNumber: 5617993190
FaxNumber: 5617993196
Practice Location
Address1: 5500 MILITARY TRL
Address2:  
City: JUPITER
State: FL
PostalCode: 334582869
CountryCode: US
TelephoneNumber: 5617993190
FaxNumber: 5617993196
Other Information
ProviderEnumerationDate: 01/09/2013
LastUpdateDate: 01/09/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPS38769FLY Pharmacy Service ProvidersPharmacist 

No ID Information.


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