Provider Demographics
NPI:1427241900
Name:CONWAY, GLENN ELLSWORTH JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ELLSWORTH
Last Name:CONWAY
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28717 GRUMMAN DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9542
Mailing Address - Country:US
Mailing Address - Phone:541-607-2000
Mailing Address - Fax:541-607-2003
Practice Address - Street 1:28717 GRUMMAN DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9542
Practice Address - Country:US
Practice Address - Phone:541-607-2000
Practice Address - Fax:541-607-2003
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0009772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist