Provider Demographics
NPI:1548932957
Name:SUDNICK, GLENN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:SUDNICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 FLOCK RD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1471
Mailing Address - Country:US
Mailing Address - Phone:609-587-1850
Mailing Address - Fax:
Practice Address - Street 1:94 FLOCK RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1471
Practice Address - Country:US
Practice Address - Phone:609-587-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03229900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist