Provider Demographics
NPI:1538750815
Name:GLASS-FRASCA, CHARLENE MARIE
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:GLASS-FRASCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 OLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1122
Mailing Address - Country:US
Mailing Address - Phone:330-717-8871
Mailing Address - Fax:
Practice Address - Street 1:9940 STATE ROUTE 43
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4938
Practice Address - Country:US
Practice Address - Phone:330-626-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03118950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist