Provider Demographics
NPI:1124500160
Name:LYNETTE R GLOCKNER, INC.
Entity type:Organization
Organization Name:LYNETTE R GLOCKNER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:GLOCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-221-7450
Mailing Address - Street 1:11451 COVESIDE PT
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2576
Mailing Address - Country:US
Mailing Address - Phone:330-221-7450
Mailing Address - Fax:
Practice Address - Street 1:10858 BUCKLEY HALL ROAD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109
Practice Address - Country:US
Practice Address - Phone:804-725-2556
Practice Address - Fax:804-725-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy