Provider Demographics
NPI:1851449516
Name:PARKMAN, GLENN NOLAN
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:NOLAN
Last Name:PARKMAN
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 1:111 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-2163
Mailing Address - Country:US
Mailing Address - Phone:229-776-3600
Mailing Address - Fax:229-776-9598
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-2163
Practice Address - Country:US
Practice Address - Phone:229-776-3600
Practice Address - Fax:229-776-9598
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist