Individual
MANDERRIOUS L GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-4000
Mailing address
723 ARBOR HILL DR, STONE MOUNTAIN, GA 30088-2363
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
RPH035275
GA
Other
Enumeration date
12/04/2025
Last updated
12/04/2025
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