Marcia Glennon, RPH – Pharmacist in Waunakee, WI

Key facts

NPI: 1104170877
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: 11574-40 (WI)
Practice address: 233 S Century Ave
Waunakee, WI 53597-1249
Phone: (608) 849-7888
Fax: (608) 849-7999
NPI assigned: Nov 2, 2012
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Registered Pharmacist

State licenses

License	State	Type	Specialty
11574-40	WI	MD	Pharmacist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	11574-40	WI	Yes

Addresses

Primary practice location

233 S Century Ave
Waunakee, WI 53597-1249

Mailing address

1927 Wallinford Cir
Sun Prairie, WI 53590-3501
Phone (608) 837-9377

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 2, 2012.

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351814400000",
    "number": "1104170877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1927 WALLINFORD CIR",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535903501",
            "telephone_number": "608-837-9377",
            "fax_number": "608-849-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 S CENTURY AVE",
            "city": "WAUNAKEE",
            "state": "WI",
            "postal_code": "535971249",
            "telephone_number": "608-849-7888",
            "fax_number": "608-849-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENNON",
        "first_name": "MARCIA",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-02",
        "last_updated": "2012-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "11574-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waunakee, WI

All providers in Waunakee, WI · Pharmacist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.