Provider Demographics
NPI:1962411918
Name:FRUM, GLENN ALEXANDER (RPH)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ALEXANDER
Last Name:FRUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97525-0259
Mailing Address - Country:US
Mailing Address - Phone:541-855-1544
Mailing Address - Fax:541-855-1040
Practice Address - Street 1:808 SECOND AVE.
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:OR
Practice Address - Zip Code:97525
Practice Address - Country:US
Practice Address - Phone:541-855-1544
Practice Address - Fax:541-855-1040
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5852OtherLICENSE NUMBER