Provider Demographics
NPI:1386247427
Name:GARRISON, GLENN SCOTT
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:SCOTT
Last Name:GARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10973 FALLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2373
Mailing Address - Country:US
Mailing Address - Phone:513-235-2692
Mailing Address - Fax:
Practice Address - Street 1:11601 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3010
Practice Address - Country:US
Practice Address - Phone:513-851-5063
Practice Address - Fax:513-851-4387
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-15160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist