Provider Demographics
NPI:1548374564
Name:GLASS, EMILY SAMPLER (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SAMPLER
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-7910
Mailing Address - Country:US
Mailing Address - Phone:770-634-5032
Mailing Address - Fax:
Practice Address - Street 1:503 ALABAMA AVE
Practice Address - Street 2:CLAYTON PHARMACY
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2007
Practice Address - Country:US
Practice Address - Phone:770-537-2382
Practice Address - Fax:770-537-0602
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist