Individual
GLENN DANIEL ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
112 MERCER ST, TCHULA, MS 39169
(662) 235-4422
Mailing address
PO BOX 217, TCHULA, MS 39169-0217
(662) 235-4422
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-07015
MS
Other
Enumeration date
03/15/2007
Last updated
05/30/2017
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