Provider Demographics
NPI:1942365523
Name:DOWDY, GLENN (RPH)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:
Last Name:DOWDY
Suffix:
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 1:1114 COTTINGHAM BLVD N
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2856
Mailing Address - Country:US
Mailing Address - Phone:843-479-7101
Mailing Address - Fax:843-479-3561
Practice Address - Street 1:1114 COTTINGHAM BLVD N
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2856
Practice Address - Country:US
Practice Address - Phone:843-479-7101
Practice Address - Fax:843-479-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2410Medicaid
SC5005690001Medicare NSC