Provider Demographics
NPI:1831677459
Name:GLOCKNER, LYNETTE RENAE (RPH)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:RENAE
Last Name:GLOCKNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11451 COVESIDE PT
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2576
Mailing Address - Country:US
Mailing Address - Phone:804-725-2556
Mailing Address - Fax:804-725-0786
Practice Address - Street 1:10858 BUCKLEY HALL RD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109
Practice Address - Country:US
Practice Address - Phone:804-725-2556
Practice Address - Fax:804-725-0786
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy