Active NPI
Odell Glenn Jr.
- Pharmacist
- Charleston, SC
National Provider Identifier
1891535951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- T-13163
- Practice address
- 51 Nassau St
Charleston, SC 29403-5513 - Phone
- (843) 722-4112
- NPI assigned
- May 28, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | T-13163 | MS | Primary |
Addresses
Primary practice location
51 Nassau St
Charleston, SC 29403-5513
Mailing address
51 Nassau St
Charleston, SC 29403-5513
Phone (843) 722-4112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-13163 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716854400000",
"number": "1891535951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 NASSAU ST",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294035513",
"telephone_number": "843-722-4112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 NASSAU ST",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294035513",
"telephone_number": "843-722-4112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "ODELL",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-28",
"last_updated": "2024-05-28",
"certification_date": "2024-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "T-13163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.