Provider Demographics
NPI:1285908483
Name:KING, GLENNA SUE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:SUE
Last Name:KING
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 N US HIGHWAY 19 E
Mailing Address - Street 2:
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-9495
Mailing Address - Country:US
Mailing Address - Phone:828-221-0174
Mailing Address - Fax:
Practice Address - Street 1:12121 S 226 HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8908
Practice Address - Country:US
Practice Address - Phone:828-765-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist