Provider Demographics
NPI:1861721649
Name:CHILDS, GLEN WILLIAM JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:WILLIAM
Last Name:CHILDS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SHADOW CREEK PARKWAY
Mailing Address - Street 2:WALGREENS 10477
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7262
Mailing Address - Country:US
Mailing Address - Phone:713-436-4913
Mailing Address - Fax:
Practice Address - Street 1:11633 SHADOW CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7262
Practice Address - Country:US
Practice Address - Phone:713-436-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist